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NPI Code Detail

MEDICARE: AMY ELIZABETH OTTESON GORRES DNP, APRN, CRNA

MEDICARE: AMY ELIZABETH OTTESON GORRES DNP, APRN, CRNA
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
1367500000XCertified Registered Nurse Anesthetist157510MN

General Provider Information

NPI Number : 1346198199
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ELIZABETH OTTESON GORRES DNP, APRN, CRNA
Provider Business Mailing Address
First Line : 4040 W 31ST ST UNIT 113
Second Line :
City : SAINT LOUIS PARK
State : MN
Zip : 55416-5382
Country : US
Telephone Number : 651-212-8543
Fax Number :
Provider Business Practice Location Address
First Line : 3300 OAKDALE AVE N
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2926
Country : US
Telephone Number : 763-520-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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