Healthcare Provider Details

I. General information

NPI: 1033640487
Provider Name (Legal Business Name): SHEILA OTERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 S LINDEN RD
FLINT MI
48507-3018
US

IV. Provider business mailing address

6549 TOWN CENTER DR SUITE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 810-957-4310
  • Fax:
Mailing address:
  • Phone: 248-620-6400
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704171220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: