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General NPI Number Information
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NPI Number | 1114423738
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Entity Type | Individual
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Provider Name | LORAN RAE POTTRUCK NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 239-270-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 12248 SHERWOOD RD
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City | BOKEELIA
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State | FL
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Zip | 33922-3308
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Country | US
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Telephone | 239-222-1447
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9235069
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | 9235069
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9235069
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License Number State | FL
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