Doctor Name: | MRS. MELANIE LYNN POTACZEK |
NPI Number: | 1184881898 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 2333-023 |
Business Practice Address: | 114 Timberlane Rd Spooner, WI - 548019687 |
Business Phone Number: | 7156353766 |
Business Fax Number: | 7146353711 |
Mailing Address: | 114 Timberlane Rd, SPOONER |
State: | WI |
Postal Code: | 548019687 |
Phone Number: | 7156353766 |
Fax Number: | 7146353711 |
NPI Enumeration Date: | 05/20/2008 |
NPI Last Update Date: | 09/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 2333-023 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |