MEDICARE: JOSEPH M POTTER LPN

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
1	164W00000X	Licensed Practical Nurse	PN.140573-M-IV	OH

General Provider Information

NPI Number	:	1881035830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH M POTTER LPN

Provider Business Mailing Address
First Line	:	4211 SNOW RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 SNOW RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2511
Country	:	US
Telephone Number	:	216-849-5950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2013
Last Update Date	:	07/07/2013

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