Provider Demographics
NPI:1790024933
Name:PORTER, ELIZA MAGDALENA (CNIM)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:MAGDALENA
Last Name:PORTER
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 REGIS CT
Mailing Address - Street 2:STE 110 PO BOX 81
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3786
Mailing Address - Country:US
Mailing Address - Phone:715-271-9608
Mailing Address - Fax:
Practice Address - Street 1:1119 REGIS CT
Practice Address - Street 2:STE 110
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3786
Practice Address - Country:US
Practice Address - Phone:715-271-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other