| NPI | 1366519514 |
|---|---|
| Former Name | HEIDI DANIELLE POTTS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 1250) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 388) |
| 363AM0700X Physician Assistant, Medical (Licence: OH 2539) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |