Healthcare Provider Details

I. General information

NPI: 1780281618
Provider Name (Legal Business Name): CZERINA OTTES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WINDING WOODS DR STE 214
O FALLON MO
63366-4773
US

IV. Provider business mailing address

300 WINDING WOODS DR STE 214
O FALLON MO
63366-4773
US

V. Phone/Fax

Practice location:
  • Phone: 636-614-3280
  • Fax:
Mailing address:
  • Phone: 636-614-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020032913
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: