Provider Demographics
NPI:1326928623
Name:POTTER, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:POTTER
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 1:2157 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SUTTER
Mailing Address - State:CA
Mailing Address - Zip Code:95982-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2157 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SUTTER
Practice Address - State:CA
Practice Address - Zip Code:95982-2517
Practice Address - Country:US
Practice Address - Phone:530-632-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293646164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse