Provider Demographics
NPI:1558886051
Name:POTRIDGE, KORTNEY BLAIR
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:BLAIR
Last Name:POTRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 BUCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3502
Mailing Address - Country:US
Mailing Address - Phone:567-280-7520
Mailing Address - Fax:
Practice Address - Street 1:1718 BUCKLAND AVENUE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420
Practice Address - Country:US
Practice Address - Phone:567-280-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker