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1487950945
MALLORY LEIGH POTTEBAUM
OMAHA, NE
NPI
1487950945
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Former Name
MALLORY LEIGH JOHNSON
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NE 1997)
Enumeration Date
2011-02-01
Last Update Date
2019-06-25
Business Address
MALLORY LEIGH POTTEBAUM PA-C
505 S. 45TH ST
OMAHA, NE 68198-0001
Phone number: 402-559-5600
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Mailing Address
MALLORY LEIGH POTTEBAUM PA-C
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198-8102
Phone number:
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