Provider Demographics
NPI:1194265744
Name:OTTE, BETHANY GRACE AVILA (FNP-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:GRACE AVILA
Last Name:OTTE
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HERRICK ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2753
Mailing Address - Country:US
Mailing Address - Phone:978-922-2226
Mailing Address - Fax:
Practice Address - Street 1:152 CONANT ST STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1659
Practice Address - Country:US
Practice Address - Phone:978-922-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95104464163W00000X
CA95006063363LP2300X
MARN2367980363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse