Provider Demographics
NPI:1962744771
Name:OTCHERE, TO NETTLE C (MED, LPN)
Entity type:Individual
Prefix:MRS
First Name:TO NETTLE
Middle Name:C
Last Name:OTCHERE
Suffix:
Gender:F
Credentials:MED, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 OPENGATE CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-5979
Mailing Address - Country:US
Mailing Address - Phone:513-259-5311
Mailing Address - Fax:
Practice Address - Street 1:5601 OPENGATE CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5979
Practice Address - Country:US
Practice Address - Phone:513-259-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH084511164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse