Healthcare Provider Details

I. General information

NPI: 1265029086
Provider Name (Legal Business Name): HOLLY POTTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 09/30/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FREDERICK AVE
AKRON OH
44310-2904
US

IV. Provider business mailing address

233 HOMAN DR
DOYLESTOWN OH
44230-1069
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-8116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number484675
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: