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NPI Code Detail

MEDICARE: JILL POTTRATZ RN

MEDICARE: JILL POTTRATZ RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse00166894WA

General Provider Information

NPI Number : 1396271672
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL POTTRATZ RN
Provider Business Mailing Address
First Line : 401 5TH AVE
Second Line : SUITE 1000
City : SEATTLE
State : WA
Zip : 98104-1818
Country : US
Telephone Number : 206-477-6936
Fax Number :
Provider Business Practice Location Address
First Line : 25742 104TH AVE SE
Second Line :
City : KENT
State : WA
Zip : 98030-7691
Country : US
Telephone Number : 206-477-6936
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2017
Last Update Date : 05/05/2017

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