Provider Demographics
NPI:1972856201
Name:PORTER, CHERYL (MS, ACNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 BRYAN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5919
Mailing Address - Country:US
Mailing Address - Phone:804-908-2663
Mailing Address - Fax:
Practice Address - Street 1:1700 BAYBERRY CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3791
Practice Address - Country:US
Practice Address - Phone:804-281-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001124845163WC0200X
VA0024170392363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine