Provider Demographics
NPI:1215493143
Name:POTTER, SHANA MARIE
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MARIE
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 DELAWARE AVE SW APT 723
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3948
Mailing Address - Country:US
Mailing Address - Phone:202-595-5694
Mailing Address - Fax:
Practice Address - Street 1:1200 DELAWARE AVE SW APT 723
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3948
Practice Address - Country:US
Practice Address - Phone:202-595-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant