Healthcare Provider Details

I. General information

NPI: 1063756450
Provider Name (Legal Business Name): MARGARET L OTEPKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 WORTHINGTON CIR
FORT COLLINS CO
80526-1840
US

IV. Provider business mailing address

802 W DRAKE RD SUITE 101
FORT COLLINS CO
80526-5558
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-6449
  • Fax:
Mailing address:
  • Phone: 970-494-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5157
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5157
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberC-APN.0000206-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: