Basic Information
| Provider Information | |||||||||
| NPI: | 1851413934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | JENNIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD, PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 970 MAKENNA ST | ||||||||
| Address2: | |||||||||
| City: | LEMOORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932454502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599240663 | ||||||||
| FaxNumber: | 5599247268 | ||||||||
| Practice Location | |||||||||
| Address1: | 970 MAKENNA ST | ||||||||
| Address2: | |||||||||
| City: | LEMOORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932454502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599240663 | ||||||||
| FaxNumber: | 5599247268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | 830844 | X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | 830844 | X | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1005X | 830844 | X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal | 133VN1006X | 830844 | X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
No ID Information.