Healthcare Provider Details

I. General information

NPI: 1134642739
Provider Name (Legal Business Name): ELLEN MARGARET POTEAU MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E BALTIMORE PIKE
MEDIA PA
19063
US

IV. Provider business mailing address

510 E BALTIMORE PIKE
MEDIA PA
19063-3836
US

V. Phone/Fax

Practice location:
  • Phone: 833-423-7334
  • Fax:
Mailing address:
  • Phone: 833-423-7334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018808
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN661199
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0047201
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18087200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: