Provider Demographics
NPI:1518095264
Name:POTASHNICK, DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:POTASHNICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0346
Mailing Address - Country:US
Mailing Address - Phone:907-852-0307
Mailing Address - Fax:
Practice Address - Street 1:4374 LAURA MADISON ST.
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723-0069
Practice Address - Country:US
Practice Address - Phone:907-852-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK397146L00000X
AK290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant