Provider Demographics
NPI:1962140004
Name:POTTS, AMBER BROOKE (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:BROOKE
Last Name:POTTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 PFINGSTEN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6427
Mailing Address - Country:US
Mailing Address - Phone:847-366-1659
Mailing Address - Fax:
Practice Address - Street 1:2155 PFINGSTEN RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6499
Practice Address - Country:US
Practice Address - Phone:224-412-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner