Healthcare Provider Details

I. General information

NPI: 1861318016
Provider Name (Legal Business Name): MEGAN ANNE OTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N INGALLS ST
ANN ARBOR MI
48109-2003
US

IV. Provider business mailing address

12626 43RD ST NE
SAINT MICHAEL MN
55376-8432
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-7985
  • Fax:
Mailing address:
  • Phone: 320-291-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2514700
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: