MEDICARE: DENISE RAYE POTTER BSN, 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
1	163WR0400X	Rehabilitation Registered Nurse	108634	IA

General Provider Information

NPI Number	:	1982482923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE RAYE POTTER BSN, RN

Provider Business Mailing Address
First Line	:	601 VALHIGH RD
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-3631
Country	:	US
Telephone Number	:	515-491-3556
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 VALHIGH RD
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-3631
Country	:	US
Telephone Number	:	515-491-3556
Fax Number	:

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

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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