Individual
SHIRLEY POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
126 OAK ST, PEORIA, IL 61602-1639
(309) 690-7790
Mailing address
126 OAK ST, PEORIA, IL 61602-1639
(309) 690-7790
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043069474
IL
Other
Enumeration date
05/16/2021
Last updated
05/16/2021
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