Healthcare Provider Details

I. General information

NPI: 1326326539
Provider Name (Legal Business Name): KAREN DIANE POTOCKI ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W FRYE RD STE 300
CHANDLER AZ
85224-6184
US

IV. Provider business mailing address

2910 N 3RD AVE
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 480-917-5600
  • Fax: 602-294-4497
Mailing address:
  • Phone: 480-917-5600
  • Fax: 602-294-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number#209003804
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP11368
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: