Provider Demographics
NPI:1154705622
Name:POTTER, JOANNA (RN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-4311
Mailing Address - Country:US
Mailing Address - Phone:580-763-6017
Mailing Address - Fax:580-763-6059
Practice Address - Street 1:201 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4311
Practice Address - Country:US
Practice Address - Phone:580-763-6017
Practice Address - Fax:580-763-6059
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0089621163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health