Provider Demographics
NPI:1609452739
Name:POTVIN, STEPHEN (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:POTVIN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1105
Mailing Address - Country:US
Mailing Address - Phone:978-806-6668
Mailing Address - Fax:978-307-5499
Practice Address - Street 1:63 NORTH ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1105
Practice Address - Country:US
Practice Address - Phone:978-806-6668
Practice Address - Fax:978-307-5499
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN57633164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse