Provider Demographics
NPI:1457376493
Name:PORTER, SUE (PAC)
Entity Type:Individual
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First Name:SUE
Middle Name:
Last Name:PORTER
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Gender:F
Credentials:PAC
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Mailing Address - Street 1:146 ACADEMY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3102
Mailing Address - Country:US
Mailing Address - Phone:207-764-3142
Mailing Address - Fax:207-764-6459
Practice Address - Street 1:146 ACADEMY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:207-764-3142
Practice Address - Fax:207-764-6459
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MEPA189363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical