Doctor Name: | MELODY OTTE |
NPI Number: | 1649686080 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CP000867 |
Business Practice Address: | 513 3rd St Sw Wagner, SD - 573809675 |
Business Phone Number: | 6054910644 |
Business Fax Number: | |
Mailing Address: | Po Box 280, WAGNER |
State: | SD |
Postal Code: | 573800280 |
Phone Number: | 6053843611 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2014 |
NPI Last Update Date: | 02/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | CP000867 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |