Individual
MALLORY LEIGH POTTEBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
505 S. 45TH ST, OMAHA, NE 68198-0001
(402) 559-5600
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1997
NE
Other
Enumeration date
02/01/2011
Last updated
06/25/2019
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