Provider Demographics
NPI:1750676367
Name:PORTER, ANGELINE GAIL (RN)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:GAIL
Last Name:PORTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGELINE
Other - Middle Name:GAIL
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10065 E HARVARD AVE
Mailing Address - Street 2:400
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5968
Mailing Address - Country:US
Mailing Address - Phone:303-614-1400
Mailing Address - Fax:303-614-1505
Practice Address - Street 1:10065 E HARVARD AVE
Practice Address - Street 2:400
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5968
Practice Address - Country:US
Practice Address - Phone:303-614-1400
Practice Address - Fax:303-614-1505
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172187163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice