Provider Demographics
NPI:1558636274
Name:POTESTA, LAURA E (PAC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:POTESTA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CORATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:135 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-4509
Mailing Address - Country:US
Mailing Address - Phone:681-342-3660
Mailing Address - Fax:681-342-3698
Practice Address - Street 1:135 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-4509
Practice Address - Country:US
Practice Address - Phone:681-342-3660
Practice Address - Fax:681-342-3698
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07575363A00000X
WV01698363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant