Provider Demographics
NPI:1710229786
Name:PORTER, CHRISTINE M (RN-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:PORTER
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 230
Mailing Address - Street 2:4-8 MAIN STREET CANASERAGA CENTRAL SCHOOL- SCHOOL NURSE
Mailing Address - City:CANASERAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14822-0230
Mailing Address - Country:US
Mailing Address - Phone:607-545-6421
Mailing Address - Fax:607-545-8393
Practice Address - Street 1:4-8 MAIN STREET
Practice Address - Street 2:CANASERAGA CENTRAL SCHOOL- SCHOOL NURSE
Practice Address - City:CANASERAGA
Practice Address - State:NY
Practice Address - Zip Code:14822-0230
Practice Address - Country:US
Practice Address - Phone:607-545-6421
Practice Address - Fax:607-545-8393
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 509960163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool