Individual
LISSETTE ALEXANDRA OTERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4405 BROADWAY, NEW YORK, NY 10040-4014
(212) 740-2020
(646) 666-0280
Mailing address
PO BOX 746087, ATLANTA, GA 30374-6087
(773) 352-1515
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
311049
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F311049
NY
Other
Enumeration date
02/02/2023
Last updated
04/13/2026
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