Individual
MS. LORAN RAE POTTRUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(239) 270-1680
Mailing address
12248 SHERWOOD RD, BOKEELIA, FL 33922-3308
(239) 222-1447
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
9235069
FL
363LF0000X
Family Nurse Practitioner
Primary
9235069
FL
363LS0200X
School Nurse Practitioner
9235069
FL
Other
Enumeration date
04/03/2018
Last updated
09/11/2020
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