Provider Demographics
NPI:1205677143
Name:POTTER, JULIANNA MARIE (NP)
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:MARIE
Last Name:POTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIANNA
Other - Middle Name:M
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 KINDER DR
Mailing Address - Street 2:
Mailing Address - City:KINDERHOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12106-2821
Mailing Address - Country:US
Mailing Address - Phone:518-755-4996
Mailing Address - Fax:
Practice Address - Street 1:71 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2927
Practice Address - Country:US
Practice Address - Phone:518-828-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354139-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty