Randall R Pottebaum

NPI #1528042223 in Burnsville, Minnesota

Provider Information

NPI Number: 1528042223
Entity Type: Individual
Name: Randall R Pottebaum
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Psychologist
Enumeration Date: Dec 6, 2005
Last Updated: Jul 8, 2007

Practice Location

Address: 14000 FAIRVIEW DR
Address 2: PARK NICOLLET CLINIC BURNSVILLE
City: Burnsville
State: Minnesota
ZIP Code: 55337-5713
Phone: (952) 993-8608

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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