Provider Demographics
NPI:1902366339
Name:PORTER, SHERYLE RENEE (NURSE AIDE)
Entity Type:Individual
Prefix:
First Name:SHERYLE
Middle Name:RENEE
Last Name:PORTER
Suffix:
Gender:F
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 JOHN R RD APT 624
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4311
Mailing Address - Country:US
Mailing Address - Phone:248-525-7318
Mailing Address - Fax:
Practice Address - Street 1:920 JOHN R RD APT 624
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4311
Practice Address - Country:US
Practice Address - Phone:248-277-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA000152722376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide