Individual
DR. NANCY LORENE OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2535 UNIVERSITY AVE SE, MINNEAPOLIS, MN 55414-3205
(612) 672-2350
Mailing address
400 STINSON BLVD, PROVIDER ENROLLMENT, MINNEAPOLIS, MN 55413
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
29631
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0214344
MEDICA
MN
01
—
1D981OT
BC/BS
MN
05
—
418083600
—
MN
01
—
FP9020802021
PREFERRED ONE
MN
Enumeration date
08/21/2006
Last updated
11/02/2018
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