Provider Demographics
NPI:1891752036
Name:POTTER, LAURA DAWN (AP, DIPLOM)
Entity Type:Individual
Prefix:MS
First Name:LAURA DAWN
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:AP, DIPLOM
Other - Prefix:MS
Other - First Name:LAURA DAWN
Other - Middle Name:
Other - Last Name:BALUSIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AP, DOM
Mailing Address - Street 1:2916 STAR APPLE CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3618
Mailing Address - Country:US
Mailing Address - Phone:727-475-4710
Mailing Address - Fax:888-300-7893
Practice Address - Street 1:2431 ESTANCIA BLVD STE A2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2608
Practice Address - Country:US
Practice Address - Phone:727-475-4710
Practice Address - Fax:888-300-7893
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1972171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist