Provider Demographics
NPI:1396906467
Name:POTTERTON, SARA WHITWELL (RN)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:WHITWELL
Last Name:POTTERTON
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 1:3209 ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3212
Mailing Address - Country:US
Mailing Address - Phone:314-368-0007
Mailing Address - Fax:
Practice Address - Street 1:3209 ARBOR AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-3212
Practice Address - Country:US
Practice Address - Phone:314-368-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO155630163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine