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General NPI Number Information
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NPI Number | 1770730996
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Entity Type | Individual
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Provider Name | DEEANE MARIE OTTO ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 194 6TH AVE NE
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City | LE MARS
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State | IA
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Zip | 51031-3716
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Country | US
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Telephone | 712-546-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 194 6TH AVE NE
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City | LE MARS
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State | IA
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Zip | 51031-3716
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1813
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A133056
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 59071
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License Number State | NE
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