Individual
SUSAN J OTTEMILLER
Active
Individual
SUSAN J OTTEMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, DNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60848345
WA
363LA2200X
Adult Health Nurse Practitioner
Primary
AP60848345
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0577260001
DMERC NUMBER
OR
01
—
1407812365
NBMC GROUP NPI NUMBER
OR
01
—
161133
GROUP NBMC MEDICAID
OR
05
—
1710964200
—
WA
05
—
500618060
—
OR
01
—
CD8723
RR MEDICARE GROUP NUMBER
OR
01
—
P00085410
RR MEDICARE PTAN NUMBER
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/27/2005
Last updated
12/07/2018
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