Provider Demographics
NPI:1831583731
Name:POTASHNICK, ANDREA (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:POTASHNICK
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 OLIVE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1691
Mailing Address - Country:US
Mailing Address - Phone:612-578-5031
Mailing Address - Fax:
Practice Address - Street 1:3180 OLIVE LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1691
Practice Address - Country:US
Practice Address - Phone:612-578-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3361133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered