Provider Demographics
NPI:1881741171
Name:PORTER, AMBER L (OTR, FNP, APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:OTR, FNP, APRN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:P
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:67 CUMMINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755
Mailing Address - Country:US
Mailing Address - Phone:603-650-8123
Mailing Address - Fax:
Practice Address - Street 1:67 CUMMINGS ROAD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755
Practice Address - Country:US
Practice Address - Phone:603-650-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1052225X00000X
NH062578-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist