Provider Demographics
NPI:1063762946
Name:OTTESEN, BROOKE LIN (APRN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LIN
Last Name:OTTESEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2102 BAPTISTE DR
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1314
Mailing Address - Country:US
Mailing Address - Phone:913-557-5678
Mailing Address - Fax:913-557-5681
Practice Address - Street 1:2102 BAPTISTE DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1314
Practice Address - Country:US
Practice Address - Phone:913-557-5678
Practice Address - Fax:913-557-5681
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-75758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner