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General NPI Number Information
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NPI Number | 1780568295
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Entity Type | Individual
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Provider Name | HEATHER ROSE OTTO PMHNP-BC
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Gender |
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 1500 NE IRVING ST STE 210
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City | PORTLAND
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State | OR
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Zip | 97232-2243
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Country | US
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Telephone | 425-477-4215
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Fax |
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE STE A
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City | PORTLAND
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State | OR
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Zip | 97239-3821
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10048385
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License Number State | OR
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