Provider Demographics
NPI:1619021078
Name:PORTER, LAURIE LEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:LEE
Last Name:PORTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8288 PORTAGE ST.
Mailing Address - Street 2:
Mailing Address - City:ONEKAMA
Mailing Address - State:MI
Mailing Address - Zip Code:49675
Mailing Address - Country:US
Mailing Address - Phone:231-889-4283
Mailing Address - Fax:231-889-4484
Practice Address - Street 1:8288 PORTAGE ST.
Practice Address - Street 2:
Practice Address - City:ONEKAMA
Practice Address - State:MI
Practice Address - Zip Code:49675
Practice Address - Country:US
Practice Address - Phone:231-889-4283
Practice Address - Fax:231-889-4484
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704150368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily