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NPI Code Detail

MEDICARE: STEPHANIE MARIE OTTUSCH

MEDICARE: STEPHANIE MARIE OTTUSCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner288359AZ
2163W00000XRegistered Nurse201141583RNOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1201141583RNOTHEROROREGON STATE BOARD OF NURSING

General Provider Information

NPI Number : 1255943775
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MARIE OTTUSCH
Provider Business Mailing Address
First Line : 4801 E BROADWAY BLVD STE 251
Second Line :
City : TUCSON
State : AZ
Zip : 85711-2700
Country : US
Telephone Number : 520-795-4783
Fax Number : 520-547-5797
Provider Business Practice Location Address
First Line : 5555 E 5TH ST STE 101
Second Line :
City : TUCSON
State : AZ
Zip : 85711-2415
Country : US
Telephone Number : 520-886-4181
Fax Number : 520-721-7536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2020
Last Update Date : 06/19/2026

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Directions to “ STEPHANIE MARIE OTTUSCH ” Practice Location

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