Basic Information
| Provider Information | |||||||||
| NPI: | 1336819549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POTTORF | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | ARIEL | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 PHEASANT COVE DR SE | ||||||||
| Address2: | |||||||||
| City: | OWENS CROSS ROADS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357633017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097389990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565333388 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2021 | ||||||||
| LastUpdateDate: | 09/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1-168543 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.