Healthcare Provider Details

I. General information

NPI: 1154540193
Provider Name (Legal Business Name): POTACIA WYNETTE FRANCIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POTACIA WYNETTE BRISTOL

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S 17TH ST
HARRISBURG PA
17104-1123
US

IV. Provider business mailing address

110 S 17TH ST
HARRISBURG PA
17104-1123
US

V. Phone/Fax

Practice location:
  • Phone: 717-232-9971
  • Fax:
Mailing address:
  • Phone: 717-232-9971
  • Fax: 717-230-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number63330
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD459185
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number243207-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: