Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lynn A Wanderer-Potter, PA-C

Individual provider Physician Assistant · NPI 1174633994

Lynn A Wanderer-Potter, PA-C is a Physician Assistant in Peoria, Arizona. Qualified in 1970, 56 years ago. Practices with Active Vital Care LLC, a 19-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
56
Licensed in
AZ
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

6739 W Cactus Rd
Peoria, AZ 85381-5311
Phone: (202) 455-0013
Fax: (623) 889-0814
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7762 (AZ)

Record details

NPI number1174633994
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 30, 2006
Last updated in NPPESAugust 8, 2022
Certification dateAugust 8, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1970 (56 years in practice)
Group practice Active Vital Care Llc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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