Provider Demographics
NPI:1013762780
Name:PORTER, ROSALYN D
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:D
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 1:202 N CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2602
Mailing Address - Country:US
Mailing Address - Phone:870-394-1219
Mailing Address - Fax:
Practice Address - Street 1:202 N CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2602
Practice Address - Country:US
Practice Address - Phone:870-394-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician