Healthcare Provider Details

I. General information

NPI: 1770789240
Provider Name (Legal Business Name): MARYBETH POTTER RN, COHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 23RD AVE N
NASHVILLE TN
37203-1503
US

IV. Provider business mailing address

2101 SALEM WOODS DR
ROCKVALE TN
37153-4159
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-0418
  • Fax: 615-340-2116
Mailing address:
  • Phone: 615-340-0418
  • Fax: 615-340-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number141140
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: