Healthcare Provider Details

I. General information

NPI: 1609024405
Provider Name (Legal Business Name): JOY LEE POTERSNAK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S IRONWOOD DR
APACHE JUNCTION AZ
85220-7100
US

IV. Provider business mailing address

2525 S IRONWOOD DR
APACHE JUNCTION AZ
85220-7100
US

V. Phone/Fax

Practice location:
  • Phone: 480-474-3982
  • Fax: 480-982-3787
Mailing address:
  • Phone: 480-474-3982
  • Fax: 480-982-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP044345
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: