Provider Demographics
NPI:1104608520
Name:POTTER, JESSICA ANNE (CLD, CCCE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:POTTER
Suffix:
Gender:F
Credentials:CLD, CCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22660 E IDA CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6669
Mailing Address - Country:US
Mailing Address - Phone:303-877-6249
Mailing Address - Fax:
Practice Address - Street 1:22660 E IDA CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6669
Practice Address - Country:US
Practice Address - Phone:303-877-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula