Provider Demographics
NPI:1619916830
Name:POTTER, CLAUDETTE D (PMHN, BC)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDETTE
Middle Name:D
Last Name:POTTER
Suffix:
Gender:F
Credentials:PMHN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 C ST
Mailing Address - Street 2:#3401
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5738
Mailing Address - Country:US
Mailing Address - Phone:608-217-0569
Mailing Address - Fax:
Practice Address - Street 1:1465 C ST
Practice Address - Street 2:#3401
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5738
Practice Address - Country:US
Practice Address - Phone:608-217-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERT 4080163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619916830OtherNPI