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General NPI Number Information
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NPI Number | 1083905103
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Entity Type | Individual
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Provider Name | MARK CLIFTON OTTOSON N.P.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2011
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Last Update Date | 04/23/2011
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Provider Practice Location Address
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Address Line | 1370 RAILROAD AVE
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City | SAINT HELENA
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State | CA
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Zip | 94574-1124
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Country | US
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Telephone | 707-963-4399
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Fax | 707-963-4796
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Provider Business Mailing Address
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Address Line | 683 CUNARD DR
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City | NAPA
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State | CA
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Zip | 94558-3628
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Country | US
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Telephone | 707-259-1410
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Fax | 707-963-4796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 429620
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License Number State | CA
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