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General NPI Number Information
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NPI Number | 1033361365
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Entity Type | Individual
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Provider Name | GLORIA J POTTER LPN
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Gender | Female
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 5368 ROUTE 32 APT 38
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City | CATSKILL
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State | NY
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Zip | 12414-6555
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Country | US
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Telephone | 518-678-3297
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 560
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City | GLASCO
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State | NY
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Zip | 12432-0560
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Country | US
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Telephone | 518-678-3297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 182597
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License Number State | NY
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