Provider Demographics
NPI:1831653302
Name:PORTICE, DANIEL (RN BSN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:PORTICE
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1601
Mailing Address - Country:US
Mailing Address - Phone:802-540-8288
Mailing Address - Fax:
Practice Address - Street 1:802 E GORHAM ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-1524
Practice Address - Country:US
Practice Address - Phone:608-280-4713
Practice Address - Fax:608-280-4707
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI244422-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse