Provider Demographics
NPI:1417792763
Name:OTTE, MERRY KATHRYN (RN)
Entity type:Individual
Prefix:
First Name:MERRY
Middle Name:KATHRYN
Last Name:OTTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MERRY
Other - Middle Name:KATHRYN
Other - Last Name:HERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:330 DOUGLASS RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 DOUGLASS RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2216
Practice Address - Country:US
Practice Address - Phone:205-563-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-182798163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine