Individual
MRS. ALICE CAMILLE OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2605 N LEBANON ST, LEBANON, IN 46052-1476
(765) 485-8000
Mailing address
2605 N LEBANON ST, LEBANON, IN 46052-1476
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28196305A
IN
208M00000X
Hospitalist Physician
Primary
71003805A
IN
363L00000X
Nurse Practitioner
71003805A
IN
363LA2100X
Acute Care Nurse Practitioner
71003805A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201042160
—
IN
Enumeration date
01/03/2011
Last updated
10/18/2023
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