Provider Demographics
NPI:1336440015
Name:OTTO, AMIE JO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:JO
Last Name:OTTO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:JO
Other - Last Name:HUEBSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:103 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3300
Mailing Address - Country:US
Mailing Address - Phone:641-421-2089
Mailing Address - Fax:
Practice Address - Street 1:103 E STATE ST
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3300
Practice Address - Country:US
Practice Address - Phone:641-421-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 192080-4363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500006303Medicare PIN