Provider Demographics
NPI:1508817545
Name:POTHIER, WANDA K (APRN-BC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:K
Last Name:POTHIER
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1509
Mailing Address - Country:US
Mailing Address - Phone:508-671-4050
Mailing Address - Fax:508-453-8050
Practice Address - Street 1:607-B SMITHFIELD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-1632
Practice Address - Country:US
Practice Address - Phone:401-885-2131
Practice Address - Fax:401-885-2131
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00218363LA2200X
MA177387363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23187Medicare UPIN