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General NPI Number Information
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NPI Number | 1629860093
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Entity Type | Individual
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Provider Name | JACQUELINE OTTERSTATTER RN
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Gender | Female
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 14000 FAIRVIEW DR
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City | BURNSVILLE
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State | MN
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Zip | 55337-5713
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Country | US
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Telephone | 952-993-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 DOWNING AVE
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City | SHAKOPEE
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State | MN
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Zip | 55379-4544
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Country | US
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Telephone | 612-709-8126
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2490796
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License Number State | MN
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