Provider Demographics
NPI:1790047447
Name:POTEMPA, NANCY ANN (LADC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:POTEMPA
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 RANDOLPH AVE
Mailing Address - Street 2:#2
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2154
Mailing Address - Country:US
Mailing Address - Phone:651-293-0721
Mailing Address - Fax:
Practice Address - Street 1:1749 RANDOLPH AVE
Practice Address - Street 2:#2
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2154
Practice Address - Country:US
Practice Address - Phone:651-293-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)