Provider Demographics
NPI:1588089908
Name:POTTER, CAROLE
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NE
Mailing Address - Zip Code:68735-0367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 E NEBRASKA STREET
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NE
Practice Address - Zip Code:68735
Practice Address - Country:US
Practice Address - Phone:402-626-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1112341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance