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NPI Code Detail

MEDICARE: ELIZABETH ANN POTTER GNP

MEDICARE: ELIZABETH ANN POTTER GNP
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
1363LG0600XGerontology Nurse Practitioner200150041NP GNP-PPOR

General Provider Information

NPI Number : 1871512624
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANN POTTER GNP
Provider Business Mailing Address
First Line : 31371 FIRECLAY RD
Second Line :
City : COTTAGE GROVE
State : OR
Zip : 97424-9203
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 RIVER AVE
Second Line :
City : EUGENE
State : OR
Zip : 97404-2507
Country : US
Telephone Number : 541-607-0897
Fax Number : 541-607-7573
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/08/2007

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