Healthcare Provider Details

I. General information

NPI: 1881704468
Provider Name (Legal Business Name): KIM MARIE POTVIN MA LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST MAILBOX 116E
WHITE RIVER JUNCTION VT
05009-0001
US

IV. Provider business mailing address

18 BANK AVE
CLAREMONT NH
03743-2218
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9363
  • Fax: 802-296-6389
Mailing address:
  • Phone: 802-295-9363
  • Fax: 802-296-6389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number000356
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: