Provider Demographics
NPI:1649202425
Name:POTTRATZ, KATHRYN A (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:POTTRATZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:IA
Mailing Address - Zip Code:50438-1242
Mailing Address - Country:US
Mailing Address - Phone:641-923-2651
Mailing Address - Fax:641-923-2652
Practice Address - Street 1:532 1ST ST NW
Practice Address - Street 2:
Practice Address - City:BRITT
Practice Address - State:IA
Practice Address - Zip Code:50423-1227
Practice Address - Country:US
Practice Address - Phone:641-843-5000
Practice Address - Fax:641-843-5001
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA043890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0440438Medicaid
IA23989OtherWELLMARK
IAS93641Medicare UPIN
IA06179Medicare ID - Type Unspecified