Provider Demographics
NPI:1093530701
Name:LAURA POTTER DNP FNP-BC CONTRACTING SERVICES LLC
Entity type:Organization
Organization Name:LAURA POTTER DNP FNP-BC CONTRACTING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:423-946-3598
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-1051
Mailing Address - Country:US
Mailing Address - Phone:276-248-0800
Mailing Address - Fax:276-248-0814
Practice Address - Street 1:19847 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614
Practice Address - Country:US
Practice Address - Phone:276-248-0800
Practice Address - Fax:276-248-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care