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General NPI Number Information
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NPI Number | 1922099696
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Entity Type | Individual
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Provider Name | MELISSA R OTTENBACHER ARNP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 450 S KITSAP BLVD STE 2300
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City | PORT ORCHARD
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State | WA
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Zip | 98366-3773
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Country | US
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Telephone | 360-895-0216
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Fax | 360-895-7919
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Provider Business Mailing Address
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Address Line | 9951 MICKELBERRY RD NW STE 101
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City | SILVERDALE
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State | WA
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Zip | 98383-8309
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Country | US
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Telephone | 360-692-9362
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Fax | 360-392-6214
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP60103856
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | RN00167987
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License Number State | WA
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