Provider Demographics
NPI:1801962816
Name:POTEETE, PRISCILLA A (LPN)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:A
Last Name:POTEETE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 NOAH AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320
Mailing Address - Country:US
Mailing Address - Phone:330-253-0761
Mailing Address - Fax:330-253-0761
Practice Address - Street 1:1941 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENINSULA
Practice Address - State:OH
Practice Address - Zip Code:44264
Practice Address - Country:US
Practice Address - Phone:330-657-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 038216164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2583440Medicaid