Individual
STEFANIE L. OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(610) 954-5810
(610) 954-5480
Mailing address
PO BOX 5520, BETHLEHEM, PA 18015-0520
(610) 954-5810
(610) 954-5490
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-538722
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
073904
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023332060003
—
PA
01
—
11754805
CAQH
PA
01
—
1550240
GATEWAY
PA
01
—
1789399
HIGHMARK BLUE SHIELD
PA
01
—
2626490000
IBC
PA
01
—
50055232
CAPITAL ADVANTAGE
PA
01
—
9426441
AETNA
PA
01
—
97452
GEISINGER
PA
Enumeration date
02/15/2006
Last updated
06/05/2020
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