Basic Information
| Provider Information | |||||||||
| NPI: | 1083236350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ASHTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | MSC10 5590 1 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722345 | ||||||||
| FaxNumber: | 5052722374 | ||||||||
| Practice Location | |||||||||
| Address1: | MSC10 5590 1 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871311702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722375 | ||||||||
| FaxNumber: | 5052722374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2020 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | NM | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.