Provider Demographics
NPI:1619106408
Name:POTTER, CHRISTINA KAELIN (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KAELIN
Last Name:POTTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:CHILCOOT
Mailing Address - State:CA
Mailing Address - Zip Code:96105-0336
Mailing Address - Country:US
Mailing Address - Phone:530-993-4342
Mailing Address - Fax:
Practice Address - Street 1:700 THIRD STREET
Practice Address - Street 2:
Practice Address - City:LOYALTON
Practice Address - State:CA
Practice Address - Zip Code:96118
Practice Address - Country:US
Practice Address - Phone:530-993-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily