Provider Demographics
NPI:1669023271
Name:POTTS, RONNIE ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:ELIZABETH
Last Name:POTTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:ELIZABETH
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11734 ROAD 33 1/2
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8465
Mailing Address - Country:US
Mailing Address - Phone:209-606-2894
Mailing Address - Fax:
Practice Address - Street 1:23638 SKY HARBOR RD.
Practice Address - Street 2:
Practice Address - City:FRIANT
Practice Address - State:CA
Practice Address - Zip Code:93626
Practice Address - Country:US
Practice Address - Phone:559-316-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily