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NPI Code Detail

MEDICARE: OLIVIA MARIE POTTER FNP

MEDICARE: OLIVIA MARIE POTTER FNP
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
1163W00000XRegistered Nurse996706NY
2363L00000XNurse Practitioner357355NY
3163W00000XRegistered NurseRN710925PA
4363L00000XNurse Practitioner0024189270VA
5363LF0000XFamily Nurse PractitionerSP025701PA
6163W00000XRegistered Nurse0001275861VA

General Provider Information

NPI Number : 1750014619
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA MARIE POTTER FNP
Provider Business Mailing Address
First Line : 158 EVERGREEN LN
Second Line :
City : CATAWISSA
State : PA
Zip : 17820-8239
Country : US
Telephone Number : 570-204-0329
Fax Number :
Provider Business Practice Location Address
First Line : 195 INTREPID LN
Second Line :
City : SYRACUSE
State : NY
Zip : 13205-2544
Country : US
Telephone Number : 844-315-2229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2022
Last Update Date : 03/04/2026

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