Healthcare Provider Details

I. General information

NPI: 1932640323
Provider Name (Legal Business Name): CINDY OTILLIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16014 DOCTORS BLVD
HAMMOND LA
70403-1478
US

IV. Provider business mailing address

16014 DOCTORS BLVD
HAMMOND LA
70403-1478
US

V. Phone/Fax

Practice location:
  • Phone: 985-340-7868
  • Fax:
Mailing address:
  • Phone: 985-340-7868
  • Fax: 985-340-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number09141
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: