Provider Demographics
NPI:1932083649
Name:POTTER, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
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 1:807 SWAIS LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MI
Mailing Address - Zip Code:49237
Mailing Address - Country:US
Mailing Address - Phone:517-399-5114
Mailing Address - Fax:
Practice Address - Street 1:807 SWAIS LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MI
Practice Address - Zip Code:49237
Practice Address - Country:US
Practice Address - Phone:517-399-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist