Individual
MRS. AMY DENISE POTHORSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
133 S MAIN ST, FREDERICKTOWN, OH 43019-1263
(740) 694-1145
Mailing address
133 S MAIN ST, FREDERICKTOWN, OH 43019-1263
(740) 694-1145
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 128710
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2794632
—
OH
Enumeration date
01/29/2008
Last updated
04/25/2011
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