Individual
LISA MARIE POTTHOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3801 S NATIONAL AVE STE 900, SPRINGFIELD, MO 65807-5210
(417) 875-3087
(417) 875-3594
Mailing address
PO BOX 802843, KANSAS CITY, MO 64180-2843
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2023000172
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420118950
—
MO
Enumeration date
01/06/2023
Last updated
02/15/2023
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