Individual
MRS. JANELLE E POTETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71003038A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000648895
ANTHEM PROVIDER NUMBER
IN
05
—
200957260
—
IN
Enumeration date
09/11/2009
Last updated
09/17/2014
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