MEDICARE: LEANN ROSE OTTOMEYER DNP, APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	7155	MN

General Provider Information

NPI Number	:	1952935512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANN ROSE OTTOMEYER DNP, APRN, FNP-C

Provider Business Mailing Address
First Line	:	4498 ROSEMARY WAY UNIT 6
Second Line	:
City	:	HUGO
State	:	MN
Zip	:	55038-6013
Country	:	US
Telephone Number	:	651-226-8438
Fax Number	:

Provider Business Practice Location Address
First Line	:	168 LAKE ST S
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-4401
Country	:	US
Telephone Number	:	651-226-8338
Fax Number	:

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

Provider Enumeration Date	:	02/23/2020
Last Update Date	:	06/19/2023

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