Healthcare Provider Details

I. General information

NPI: 1588089908
Provider Name (Legal Business Name): CAROLE POTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E NEBRASKA STREET
EWING NE
68735
US

IV. Provider business mailing address

PO BOX 367
EWING NE
68735-0367
US

V. Phone/Fax

Practice location:
  • Phone: 402-626-7262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1112
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: