Provider Demographics
NPI:1790487262
Name:POTTS, AMANDA (LPN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:12886 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1206
Mailing Address - Country:US
Mailing Address - Phone:716-387-8384
Mailing Address - Fax:
Practice Address - Street 1:12886 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1206
Practice Address - Country:US
Practice Address - Phone:716-387-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338627-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse