Provider Demographics
NPI:1417009390
Name:POTTER, ANN BARTZ (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:BARTZ
Last Name:POTTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:116 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-8363
Mailing Address - Country:US
Mailing Address - Phone:336-368-4079
Mailing Address - Fax:336-770-1490
Practice Address - Street 1:1533 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-2738
Practice Address - Country:US
Practice Address - Phone:336-770-3288
Practice Address - Fax:336-770-1490
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily