Individual
SUSAN J OTTEMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, DNP
Contact information
Practice address
825 EASTLAKE AVE E, SEATTLE, WA 98109
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5400
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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