Provider Demographics
NPI:1609024405
Name:POTERSNAK, JOY LEE (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOY
Middle Name:LEE
Last Name:POTERSNAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-7100
Mailing Address - Country:US
Mailing Address - Phone:480-474-3982
Mailing Address - Fax:480-982-3787
Practice Address - Street 1:2525 S IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-7100
Practice Address - Country:US
Practice Address - Phone:480-474-3982
Practice Address - Fax:480-982-3787
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP044345164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse