Provider Demographics
NPI:1477943298
Name:POTTER, AMANDA (BS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OLD BARN RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-1726
Mailing Address - Country:US
Mailing Address - Phone:860-707-4500
Mailing Address - Fax:
Practice Address - Street 1:16 OLD BARN RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-1726
Practice Address - Country:US
Practice Address - Phone:860-707-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker