Provider Demographics
NPI:1962187146
Name:POTTS, ROSA YI (RN)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:YI
Last Name:POTTS
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 1:505 FINNEGAN RDG UNIT 2
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-7271
Mailing Address - Country:US
Mailing Address - Phone:407-921-9367
Mailing Address - Fax:
Practice Address - Street 1:1117 SPRING ST
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-9782
Practice Address - Country:US
Practice Address - Phone:407-921-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9348676163W00000X
GA61352061163W00000X
WA61352061163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse