Provider Demographics
NPI:1013739895
Name:PORTER, JENAE B (BSN, RN)
Entity type:Individual
Prefix:
First Name:JENAE
Middle Name:B
Last Name:PORTER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252-8907
Mailing Address - Country:US
Mailing Address - Phone:360-691-7717
Mailing Address - Fax:425-412-8493
Practice Address - Street 1:1201 100TH ST NE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8632
Practice Address - Country:US
Practice Address - Phone:360-691-7718
Practice Address - Fax:425-412-8493
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61521018163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool