Provider Demographics
NPI:1770789240
Name:POTTER, MARYBETH (RN, COHN)
Entity type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:RN, COHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SALEM WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVALE
Mailing Address - State:TN
Mailing Address - Zip Code:37153-4159
Mailing Address - Country:US
Mailing Address - Phone:615-340-0418
Mailing Address - Fax:615-340-2116
Practice Address - Street 1:311 23RD AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1503
Practice Address - Country:US
Practice Address - Phone:615-340-0418
Practice Address - Fax:615-340-2116
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN141140163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health