Susan L Porter, RN

Individual provider Active NPI Registered Nurse · Preston, CT

NPI 1295044915 · NPPES record last updated Sep 29, 2010

Key facts

NPI
1295044915
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
072997 (CT)
Practice address
289 Miller Rd
Preston, CT 06365-8533
Phone
(860) 887-9195
NPI assigned
Sep 29, 2010
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
072997CTMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 072997 CT Yes

Addresses

Primary practice location

289 Miller Rd
Preston, CT 06365-8533

Mailing address

289 Miller Rd
Preston, CT 06365-8533
Phone (860) 887-9195

Other providers in Preston, CT

All providers in Preston, CT · Registered Nurse in Connecticut

Sources for this page

Verify at the official NPI Registry.