Healthcare Provider Details

I. General information

NPI: 1750396404
Provider Name (Legal Business Name): NATALIE LYNN POTRAMENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 11TH ST SUITE 101
SPENCER IA
51301-4364
US

IV. Provider business mailing address

116 E 11TH ST SUITE 101
SPENCER IA
51301-4364
US

V. Phone/Fax

Practice location:
  • Phone: 712-264-3500
  • Fax: 712-264-3535
Mailing address:
  • Phone: 712-264-3500
  • Fax: 712-264-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP000498
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number105928
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-091009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: