Individual
JENNIFER MICHELLE OTERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
259525
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
4704224988
MI
367500000X
Certified Registered Nurse Anesthetist
COA.11946-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2373391
—
OH
Enumeration date
06/07/2006
Last updated
01/13/2020
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