Healthcare Provider Details

I. General information

NPI: 1699499582
Provider Name (Legal Business Name): ANN OTTESEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 NE BELLEVUE DR STE 200
BEND OR
97701-8744
US

IV. Provider business mailing address

2660 NE HIGHWAY 20 SUITE 610 #524
BEND OR
97701-4858
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-7243
  • Fax: 541-645-7243
Mailing address:
  • Phone: 541-762-2727
  • Fax: 541-645-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2022124070NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2022124070NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2022124070NP-PP
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202212407NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: