Healthcare Provider Details

I. General information

NPI: 1437984242
Provider Name (Legal Business Name): CASSIDY OTTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E UNIVERSITY BLVD
TUCSON AZ
85721-0001
US

IV. Provider business mailing address

14145 N 92ND ST UNIT 2065
SCOTTSDALE AZ
85260-3716
US

V. Phone/Fax

Practice location:
  • Phone: 520-621-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number296693
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: