Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 119657 | IA |
NPI | 1003338286 |
---|---|
Provider Name | Carrie Potter |
First Address | Mason City, IA 50401-5489 |
Second Address | Mason City, IA 50401-1612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 27/07/2020 |