Provider Demographics
NPI:1750396404
Name:POTRAMENT, NATALIE LYNN (NP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LYNN
Last Name:POTRAMENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 11TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4364
Mailing Address - Country:US
Mailing Address - Phone:712-264-3500
Mailing Address - Fax:712-264-3535
Practice Address - Street 1:116 E 11TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4364
Practice Address - Country:US
Practice Address - Phone:712-264-3500
Practice Address - Fax:712-264-3535
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105928363LF0000X
SDCP000498363L00000X
IAA-091009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1750396404Medicaid
MO428765309Medicaid
SDP00467905Medicare PIN
MO428765309Medicaid
IA1750396404Medicare PIN
MOM40C135Medicare ID - Type Unspecified
IA1750396404Medicaid