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General NPI Number Information
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NPI Number | 1750014619
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Entity Type | Individual
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Provider Name | OLIVIA MARIE POTTER FNP
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Gender | Female
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Dates
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Enumeration Date | 07/07/2022
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 195 INTREPID LN
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City | SYRACUSE
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State | NY
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Zip | 13205-2544
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Country | US
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Telephone | 844-315-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 158 EVERGREEN LN
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City | CATAWISSA
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State | PA
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Zip | 17820-8239
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Country | US
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Telephone | 570-204-0329
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN710925
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024189270
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 357355
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP025701
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 996706
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001275861
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License Number State | VA
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