Provider Demographics
NPI:1346416419
Name:POTTS, NOVELLA (LVN)
Entity Type:Individual
Prefix:
First Name:NOVELLA
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3046 E BALCH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2452
Mailing Address - Country:US
Mailing Address - Phone:559-916-0803
Mailing Address - Fax:
Practice Address - Street 1:1638 L ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1118
Practice Address - Country:US
Practice Address - Phone:559-268-2205
Practice Address - Fax:559-268-2245
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN194949164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse