Provider Demographics
NPI:1285448084
Name:OTTERNESS, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:OTTERNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45988 150TH ST
Mailing Address - Street 2:
Mailing Address - City:MABEL
Mailing Address - State:MN
Mailing Address - Zip Code:55954-1254
Mailing Address - Country:US
Mailing Address - Phone:507-421-0408
Mailing Address - Fax:
Practice Address - Street 1:45988 150TH ST
Practice Address - Street 2:
Practice Address - City:MABEL
Practice Address - State:MN
Practice Address - Zip Code:55954-1254
Practice Address - Country:US
Practice Address - Phone:507-421-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife