MEDICARE: MISS ALEXANDRA CHRISTINE POTTER R.N.

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	163WH0200X	Home Health Registered Nurse	686205	NY
2	163WN0002X	Neonatal Intensive Care Registered Nurse	686205	NY

General Provider Information

NPI Number	:	1912383167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALEXANDRA CHRISTINE POTTER R.N.

Provider Business Mailing Address
First Line	:	15 KEMP AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-7278
Country	:	US
Telephone Number	:	518-229-5589
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 KEMP AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-7278
Country	:	US
Telephone Number	:	518-229-5589
Fax Number	:

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

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	08/10/2015

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