MEDICARE: MRS. MELISSA R OTTENBACHER ARNP

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	363LP0200X	Pediatric Nurse Practitioner	AP60103856	WA
2	364SP0200X	Pediatric Clinical Nurse Specialist	RN00167987	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RN00167987	OTHER	WA	RN
3	AP60103856	OTHER	WA	ARNP LICENSE

General Provider Information

NPI Number	:	1922099696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA R OTTENBACHER ARNP

Provider Business Mailing Address
First Line	:	9951 MICKELBERRY RD NW
Second Line	:	STE 101
City	:	SILVERDALE
State	:	WA
Zip	:	98383-8309
Country	:	US
Telephone Number	:	360-692-9362
Fax Number	:	360-392-6214

Provider Business Practice Location Address
First Line	:	450 S KITSAP BLVD
Second Line	:	STE 2300
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3773
Country	:	US
Telephone Number	:	360-895-0216
Fax Number	:	360-895-7919

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	03/07/2023

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Directions to “ MRS. MELISSA R OTTENBACHER ARNP” Practice Location

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