Provider Demographics
NPI:1801852090
Name:PORTER, CHRIS L (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:L
Last Name:PORTER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13684
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98198-1010
Mailing Address - Country:US
Mailing Address - Phone:206-592-5000
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:16259 SYLVESTER ROAD SW
Practice Address - Street 2:SUITE 404
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-241-1818
Practice Address - Fax:206-244-3991
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006421363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00355642OtherRR MEDICARE
WA9644667Medicaid
WAG8859766Medicare PIN
WAQ19980Medicare UPIN
WA9644667Medicaid