Provider Demographics
NPI:1699499582
Name:OTTESEN, ANN (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:OTTESEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 NE HIGHWAY 20 SUITE 610 #524
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4858
Mailing Address - Country:US
Mailing Address - Phone:541-762-2727
Mailing Address - Fax:541-645-7243
Practice Address - Street 1:527 NE BELLEVUE DR STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8744
Practice Address - Country:US
Practice Address - Phone:541-640-7243
Practice Address - Fax:541-645-7243
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2022124070NP-PP363LA2200X, 363LG0600X, 363LP2300X
OR202212407NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500812411Medicaid