Provider Demographics
NPI:1346215142
Name:POTTER, DONNA M (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:POTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3063
Mailing Address - Country:US
Mailing Address - Phone:508-775-1984
Mailing Address - Fax:508-790-1897
Practice Address - Street 1:100 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3063
Practice Address - Country:US
Practice Address - Phone:508-775-1984
Practice Address - Fax:508-790-1897
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176514363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4243OtherBCBS
MANP424301Medicare PIN
MANP4243OtherBCBS