Individual
TODD MATTHEW POTTORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 MEDICAL PARK BLVD, BRISTOL, TN 37620-7430
(423) 844-2686
(423) 844-2686
Mailing address
105 W STONE DR STE 6A, KINGSPORT, TN 37660-3256
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
94422
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
22624
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94422
RN LICENSE
SC
Enumeration date
02/04/2013
Last updated
02/20/2018
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