Provider Demographics
NPI:1215472352
Name:POTTER, TAMMY JO (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
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 1:117 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1252
Mailing Address - Country:US
Mailing Address - Phone:315-493-4187
Mailing Address - Fax:315-493-4188
Practice Address - Street 1:117 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1252
Practice Address - Country:US
Practice Address - Phone:315-493-4187
Practice Address - Fax:315-493-4188
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY566380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse