Individual
MS. STACEY L POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, MTI, BS
Contact information
Practice address
313 N MONTEREY AVE, FARMINGTON, NM 87401-6957
(505) 701-4164
Mailing address
313 N MONTEREY AVE, FARMINGTON, NM 87401-6957
(505) 701-4164
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
# 7128
NM
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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