Provider Demographics
NPI:1578984837
Name:PORTER, REBECCA (DEM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 E 700 S
Mailing Address - Street 2:APT 1
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-915-0269
Mailing Address - Fax:
Practice Address - Street 1:553 E 700 S
Practice Address - Street 2:APT 1
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-3580
Practice Address - Country:US
Practice Address - Phone:801-915-0269
Practice Address - Fax:801-396-7101
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife