Basic Information
Provider Information | |||||||||
NPI: | 1396980900 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHRIS PORTER ARNP LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 16259 SYLVESTER RD SW | ||||||||
Address2: | SUITE 404 | ||||||||
City: | BURIEN | ||||||||
State: | WA | ||||||||
PostalCode: | 981663049 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2062433049 | ||||||||
FaxNumber: | 2062443991 | ||||||||
Practice Location | |||||||||
Address1: | 3819 100TH ST SW | ||||||||
Address2: | SUITE 7-C | ||||||||
City: | LAKEWOOD | ||||||||
State: | WA | ||||||||
PostalCode: | 984994470 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535887911 | ||||||||
FaxNumber: | 2539846774 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/10/2008 | ||||||||
LastUpdateDate: | 12/10/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PORTER | ||||||||
AuthorizedOfficialFirstName: | CHRIS | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
AuthorizedOfficialTelephone: | 2062433049 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | ARNP | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WI0600X | AP30006421 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Infection Control |
ID Information
ID | Type | State | Issuer | Description | 0208202 | 01 | WA | LABOR & INDUSTRIES | OTHER |