Individual
DEMERISE OTT MINOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3 RICHLAND MEDICAL PARK DR, SUITE 310, COLUMBIA, SC 29203-6849
(803) 434-8323
(803) 434-8326
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
APN766
SC
363LF0000X
Family Nurse Practitioner
Primary
766
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0587
—
SC
Enumeration date
04/25/2006
Last updated
04/12/2023
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