Individual
TOMMIE OTT
Active
Individual
TOMMIE OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28174042A
IN
363LW0102X
Women's Health Nurse Practitioner
Primary
71006022A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000993789
ANTHEM PROVIDER NUMBER
IN
05
—
201342030
—
IN
Enumeration date
12/04/2015
Last updated
02/09/2021
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