Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN303075 | OH |
NPI | 1023347754 |
---|---|
Provider Name | Ms. Jodi Annette Potterton |
First Address | Wright Patterson Afb, OH 45433-5529 |
Second Address | Wright Patterson Afb, OH 45433-5529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2009 |
Last Update Date | 01/12/2014 |