Provider Demographics
NPI:1972168045
Name:PORTER, CHLOE S (PAC)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:S
Last Name:PORTER
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:1130 NW 22ND AVE STE 640
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5488
Mailing Address - Country:US
Mailing Address - Phone:503-229-7976
Mailing Address - Fax:503-274-4867
Practice Address - Street 1:9155 SW BARNES RD STE 402
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6631
Practice Address - Country:US
Practice Address - Phone:503-292-7704
Practice Address - Fax:503-292-7046
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2021-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORPA203025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical