Provider Demographics
NPI:1033361365
Name:POTTER, GLORIA J (LPN)
Entity Type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:J
Last Name:POTTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:GLASCO
Mailing Address - State:NY
Mailing Address - Zip Code:12432-0560
Mailing Address - Country:US
Mailing Address - Phone:518-678-3297
Mailing Address - Fax:
Practice Address - Street 1:5368 ROUTE 32
Practice Address - Street 2:APT 38
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-6555
Practice Address - Country:US
Practice Address - Phone:518-678-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182597164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse