Provider Demographics
NPI:1891032793
Name:POTORAC, ZINAIDA (ACNP, CCNS)
Entity Type:Individual
Prefix:
First Name:ZINAIDA
Middle Name:
Last Name:POTORAC
Suffix:
Gender:F
Credentials:ACNP, CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ROSS DR SW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6723
Mailing Address - Country:US
Mailing Address - Phone:703-851-7783
Mailing Address - Fax:
Practice Address - Street 1:1215 ROSS DR SW
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6723
Practice Address - Country:US
Practice Address - Phone:703-851-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1023604163W00000X
VA0001197517163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse