Provider Demographics
NPI:1740897818
Name:POTOCKI, RONALD J JR (LPN)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:POTOCKI
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8771 FINDLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-4273
Mailing Address - Country:US
Mailing Address - Phone:814-881-2563
Mailing Address - Fax:
Practice Address - Street 1:8771 FINDLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-4273
Practice Address - Country:US
Practice Address - Phone:814-881-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN266404164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse