Provider Demographics
NPI:1366909699
Name:OTT, DANIELLE (CRNA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:GOEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2330 FLEET ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3624
Mailing Address - Country:US
Mailing Address - Phone:516-312-8365
Mailing Address - Fax:
Practice Address - Street 1:500 UPPER CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4324
Practice Address - Country:US
Practice Address - Phone:443-643-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676976367500000X
NY676976-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse