Provider Demographics
NPI:1750412003
Name:PORTER, NORMA S (APRN)
Entity type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:S
Last Name:PORTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2527
Mailing Address - Country:US
Mailing Address - Phone:318-443-5845
Mailing Address - Fax:
Practice Address - Street 1:2351 VANDENBURG DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-5609
Practice Address - Country:US
Practice Address - Phone:318-483-7113
Practice Address - Fax:318-483-7244
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP 02060363LF0000X
LARN 043469163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA541788Medicaid
LA4B448Medicare ID - Type Unspecified
LA541788Medicaid