Individual
GRACE POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HIS
Contact information
Practice address
1201 WENTZVILLE PKWY STE 115, WENTZVILLE, MO 63385-3498
(636) 922-5000
Mailing address
202 W COLUMBIA ST, FARMINGTON, MO 63640-1705
(636) 219-1535
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
2024015357
MO
Other
Enumeration date
05/10/2024
Last updated
05/10/2024
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