Provider Demographics
NPI:1356720890
Name:PORTER, DEANNA GAIL (28427-31)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:GAIL
Last Name:PORTER
Suffix:
Gender:F
Credentials:28427-31
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 S THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1982
Mailing Address - Country:US
Mailing Address - Phone:608-228-7902
Mailing Address - Fax:
Practice Address - Street 1:1706 S THOMPSON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1982
Practice Address - Country:US
Practice Address - Phone:608-228-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28427-31251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF-11259OtherPRIVATE DUTY NURSING FOR MEMBERS VENTILATOR DEPENDENT FOR LIFE-SUPPORT PEDIATRIC
WIF-11258OtherPRIVATE DUTY NURSING FOR MEMBERS VENTILATOR DEPENDENT FOR LIFE-SUPPORT ADULT