Healthcare Provider Details

I. General information

NPI: 1043005408
Provider Name (Legal Business Name): NATALIE LYNN POTHEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22978 BUTTERFIELD DR NW
SAINT FRANCIS MN
55070-7710
US

IV. Provider business mailing address

22978 BUTTERFIELD DR NW
SAINT FRANCIS MN
55070-7710
US

V. Phone/Fax

Practice location:
  • Phone: 763-230-9248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8387-23
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15299
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: