Provider Demographics
NPI:1033945399
Name:POTWIN, GINGER L (BS,BCC)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:L
Last Name:POTWIN
Suffix:
Gender:F
Credentials:BS,BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 BRAINSTORM RD APT S2
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:VT
Mailing Address - Zip Code:05060-4415
Mailing Address - Country:US
Mailing Address - Phone:802-782-4466
Mailing Address - Fax:802-728-4197
Practice Address - Street 1:11 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1126
Practice Address - Country:US
Practice Address - Phone:802-728-4466
Practice Address - Fax:802-728-4197
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator