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General NPI Number Information
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NPI Number | 1689720047
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Entity Type | Individual
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Provider Name | MRS. LISA OTIS
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 227 CEDAR ST
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City | SEVIERVILLE
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State | TN
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Zip | 37862-3838
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Country | US
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Telephone | 865-453-1032
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 LEWELLING CT
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City | KODAK
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State | TN
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Zip | 37764-1683
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Country | US
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Telephone | 865-933-1121
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN0000152532
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License Number State | TN
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