Healthcare Provider Details

I. General information

NPI: 1194477620
Provider Name (Legal Business Name): CHRISTOPHER M OTTEMOELLER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 09/07/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E BROADWAY ST
HELENA MT
59601-4905
US

IV. Provider business mailing address

2635 PIKE DR
EAST HELENA MT
59635-3439
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-217325
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-217325
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: