MEDICARE: CAROLE JENNIFER OTTERSTATTER R,N.

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
1	163W00000X	Registered Nurse	205327-1	NY

General Provider Information

NPI Number	:	1609145788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE JENNIFER OTTERSTATTER R,N.

Provider Business Mailing Address
First Line	:	125 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5502
Country	:	US
Telephone Number	:	585-342-4000
Fax Number	:	585-342-4694

Provider Business Practice Location Address
First Line	:	125 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5502
Country	:	US
Telephone Number	:	585-342-4000
Fax Number	:	585-342-4694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	02/08/2026

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Directions to “ CAROLE JENNIFER OTTERSTATTER R,N.” Practice Location

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