Provider Demographics
NPI:1164281093
Name:POTONIC, KRISTINA J
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:J
Last Name:POTONIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 TOLLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1813
Mailing Address - Country:US
Mailing Address - Phone:440-623-4855
Mailing Address - Fax:
Practice Address - Street 1:767 TOLLIS PKWY
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1813
Practice Address - Country:US
Practice Address - Phone:440-623-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver