Provider Demographics
NPI:1750655874
Name:POTTER, JULIA MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:MARIE
Last Name:POTTER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1622
Mailing Address - Country:US
Mailing Address - Phone:570-265-6246
Mailing Address - Fax:570-265-6337
Practice Address - Street 1:4 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1622
Practice Address - Country:US
Practice Address - Phone:570-265-6246
Practice Address - Fax:570-265-6337
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN304108L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse