Poulson-Port, Andrea Jo

Poulson-Port, Andrea Jo is an individual health care provider with primary practice located at 4100 Dewey St , Manitowoc WI 54220-5497. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Poulson-Port, Andrea Jo can be contacted via phone (920) 686-5700.

Contact Information

Primary practice address
4100 Dewey St Manitowoc WI 54220-5497
Phone: (920) 686-5700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 56118-20 Wisconsin

Profile Details

NPI number 1326280611
LBN Legal business name Poulson-Port, Andrea Jo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 1st, 2009
Last updated Dec 1st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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