Provider Demographics
NPI:1174687867
Name:POTAMPA, KAREN V (NMNP-PP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:V
Last Name:POTAMPA
Suffix:
Gender:F
Credentials:NMNP-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1827
Mailing Address - Country:US
Mailing Address - Phone:541-475-3874
Mailing Address - Fax:541-475-3503
Practice Address - Street 1:76 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1827
Practice Address - Country:US
Practice Address - Phone:541-475-3874
Practice Address - Fax:541-475-3503
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26221N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR040407Medicaid
ORS07062Medicare UPIN
OR040407Medicaid