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NPI Code Detail

MEDICARE: MRS. CLAUDETTE D POTTER PMHN, BC

MEDICARE: MRS. CLAUDETTE D POTTER PMHN, BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0809XAdult Psychiatric/Mental Health Registered NurseCERT 4080CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11619916830OTHERWINPI

General Provider Information

NPI Number : 1619916830
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CLAUDETTE D POTTER PMHN, BC
Provider Business Mailing Address
First Line : 1465 C ST
Second Line : #3401
City : SAN DIEGO
State : CA
Zip : 92101-5738
Country : US
Telephone Number : 608-217-0569
Fax Number :
Provider Business Practice Location Address
First Line : 1465 C ST
Second Line : #3401
City : SAN DIEGO
State : CA
Zip : 92101-5738
Country : US
Telephone Number : 608-217-0569
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 12/20/2013

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