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General NPI Number Information
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NPI Number | 1538312590
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Entity Type | Individual
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Provider Name | LONNA MARIE POTTER CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 2820 MOUNT RUSHMORE RD
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City | RAPID CITY
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State | SD
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Zip | 57701-5462
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Country | US
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Telephone | 605-484-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 5440 TIMBERLINE TRL
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City | RAPID CITY
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State | SD
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Zip | 57702-1806
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R033602
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R29308
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CR000712
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License Number State | SD
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