Provider Demographics
NPI:1205609559
Name:POTTEBAUM, ERIKA ELIZABETH
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:ELIZABETH
Last Name:POTTEBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:IA
Mailing Address - Zip Code:51239-7448
Mailing Address - Country:US
Mailing Address - Phone:712-541-7105
Mailing Address - Fax:
Practice Address - Street 1:1415 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:IA
Practice Address - Zip Code:51239-7448
Practice Address - Country:US
Practice Address - Phone:712-541-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer