MEDICARE: JENNIFER MARIE OTERO FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	73721	NM

General Provider Information

NPI Number	:	1881387736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE OTERO FNP-BC

Provider Business Mailing Address
First Line	:	7209 VALLE JARDIN LN NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-6408
Country	:	US
Telephone Number	:	505-908-6502
Fax Number	:

Provider Business Practice Location Address
First Line	:	8650 ALAMEDA BLVD NE STE 101E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3791
Country	:	US
Telephone Number	:	505-255-1866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	05/29/2023

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