Healthcare Provider Details

I. General information

NPI: 1336026921
Provider Name (Legal Business Name): DAVID POTRATZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST TOWER B STE 405
LINCOLN NE
68502-3793
US

IV. Provider business mailing address

PO BOX 860876
MINNEAPOLIS MN
55486-0876
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-5860
  • Fax:
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3320
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: