Provider Demographics
NPI:1548508070
Name:POTVIN, ALINE RENEE (ND)
Entity type:Individual
Prefix:DR
First Name:ALINE
Middle Name:RENEE
Last Name:POTVIN
Suffix:
Gender:F
Credentials:ND
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 43
Mailing Address - Street 2:
Mailing Address - City:WEST FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04992-0043
Mailing Address - Country:US
Mailing Address - Phone:207-650-7410
Mailing Address - Fax:
Practice Address - Street 1:21 CUMMINGS HILL ROAD
Practice Address - Street 2:APT 3
Practice Address - City:TEMPLE
Practice Address - State:ME
Practice Address - Zip Code:04984
Practice Address - Country:US
Practice Address - Phone:207-650-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME#NP394175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath