Provider Demographics
NPI:1639348287
Name:PORTER, LALA RENEE (RN)
Entity Type:Individual
Prefix:
First Name:LALA
Middle Name:RENEE
Last Name:PORTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12490 BASIL RD NW
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9641
Mailing Address - Country:US
Mailing Address - Phone:740-862-6320
Mailing Address - Fax:
Practice Address - Street 1:12490 BASIL RD NW
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-9641
Practice Address - Country:US
Practice Address - Phone:740-862-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN276640163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse