Provider Demographics
NPI:1659349124
Name:PORSCH, KATHLEEN M (CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:PORSCH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ROUTE 72 W
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2468
Mailing Address - Country:US
Mailing Address - Phone:609-978-9841
Mailing Address - Fax:609-978-9843
Practice Address - Street 1:1100 ROUTE 72 W
Practice Address - Street 2:SUITE 305
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2468
Practice Address - Country:US
Practice Address - Phone:609-978-9841
Practice Address - Fax:609-978-9843
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00032601176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8923205Medicaid
NJ8923205Medicaid