Provider Demographics
NPI:1770852113
Name:POTTS, SANDRA D (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:D
Last Name:POTTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3644
Mailing Address - Country:US
Mailing Address - Phone:216-509-6108
Mailing Address - Fax:
Practice Address - Street 1:3002 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3644
Practice Address - Country:US
Practice Address - Phone:216-509-6108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.344751-163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health