Provider Demographics
NPI:1730113069
Name:POTEET, SYLVIA L (CRNA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:L
Last Name:POTEET
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 OVERTON PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4415
Mailing Address - Country:US
Mailing Address - Phone:817-529-1147
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:925 SANTA FE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5866
Practice Address - Country:US
Practice Address - Phone:817-599-4901
Practice Address - Fax:817-599-4902
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228621367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86157HMedicare ID - Type Unspecified