Provider Demographics
NPI:1548265820
Name:POTTS, STEPHANIE HARPER (FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HARPER
Last Name:POTTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-0149
Mailing Address - Country:US
Mailing Address - Phone:503-359-8501
Mailing Address - Fax:503-434-8597
Practice Address - Street 1:627 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-434-7523
Practice Address - Fax:503-434-8597
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORANP 0319OtherWORKER'S COMP
WA9644881OtherWA DSHS PROVIDER
OR100376Medicaid
WA9644881OtherWA DSHS PROVIDER