Individual
KENNETH K POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
1401 EAST 12TH STREET, MENDOTA, IL 61342-9216
(815) 539-7461
(815) 539-1461
Mailing address
1401 EAST 12TH STREET, MENDOTA, IL 61342-9216
(815) 539-7461
(815) 539-1461
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041136641
IL
Other
Enumeration date
07/26/2006
Last updated
12/30/2011
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