Provider Demographics
NPI:1609853308
Name:POTTER, MARCIA ALYSE (NP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ALYSE
Last Name:POTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ALYSE
Other - Last Name:POST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:19 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-9679
Mailing Address - Country:US
Mailing Address - Phone:302-730-3604
Mailing Address - Fax:
Practice Address - Street 1:300 TUSKEGEE BLVD
Practice Address - Street 2:
Practice Address - City:DOVER AFB
Practice Address - State:DE
Practice Address - Zip Code:19902-5300
Practice Address - Country:US
Practice Address - Phone:302-677-2669
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71000978A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care