Provider Demographics
NPI:1932679925
Name:MCINTOSH-CADE, PORTIA ORELL (NP)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:ORELL
Last Name:MCINTOSH-CADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31500 TELEGRAPH RD STE 115
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4302
Mailing Address - Country:US
Mailing Address - Phone:248-621-9100
Mailing Address - Fax:
Practice Address - Street 1:31500 TELEGRAPH RD STE 115
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4302
Practice Address - Country:US
Practice Address - Phone:248-621-9100
Practice Address - Fax:248-621-9111
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217916NSA1814V363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner