Provider Demographics
NPI:1104170703
Name:POTTS-DAFLER, VICKI MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:MICHELLE
Last Name:POTTS-DAFLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:MICHELLE
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:228 TROY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1831
Mailing Address - Country:US
Mailing Address - Phone:937-228-8132
Mailing Address - Fax:
Practice Address - Street 1:228 TROY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1831
Practice Address - Country:US
Practice Address - Phone:937-228-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 13984-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily