Individual
CHRISTINE A. POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
420 N STATE ROUTE 31, CRYSTAL LAKE, IL 60012-3709
(815) 788-2018
Mailing address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3709
(815) 356-5200
(815) 356-5262
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007362
IL
363A00000X
Physician Assistant
4207-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/14/2017
Last updated
10/18/2019
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