Healthcare Provider Details

I. General information

NPI: 1669295580
Provider Name (Legal Business Name): DANA OTTMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

701 5TH AVE N
CASSELTON ND
58012-2808
US

V. Phone/Fax

Practice location:
  • Phone: 701-290-2846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR37574
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: