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NPI Code Detail

MEDICARE: MRS. HEIDI J. OTTO APRN, IBCLC, CNP

MEDICARE:  MRS. HEIDI J. OTTO  APRN, IBCLC, CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WL0100XLactation Consultant (Registered Nurse)R113572-5MN
2363LF0000XFamily Nurse PractitionerF1014544MN

General Provider Information

NPI Number : 1649471178
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEIDI J. OTTO APRN, IBCLC, CNP
Provider Business Mailing Address
First Line : 1900 SUNRISE DR
Second Line :
City : SAINT PETER
State : MN
Zip : 56082-5376
Country : US
Telephone Number : 507-934-8480
Fax Number :
Provider Business Practice Location Address
First Line : 1900 SUNRISE DR
Second Line :
City : SAINT PETER
State : MN
Zip : 56082-5376
Country : US
Telephone Number : 507-934-8480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2007
Last Update Date : 02/18/2015

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Directions to “ MRS. HEIDI J. OTTO APRN, IBCLC, CNP” Practice Location

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