Provider Demographics
NPI:1013618354
Name:PORTER, ROMELDA NANNETTE
Entity Type:Individual
Prefix:
First Name:ROMELDA
Middle Name:NANNETTE
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1405
Mailing Address - Country:US
Mailing Address - Phone:304-725-4044
Mailing Address - Fax:
Practice Address - Street 1:103 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1405
Practice Address - Country:US
Practice Address - Phone:304-725-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant