Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 186150-8017 | UT |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 186150-1205 | UT |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 46598 | AZ |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 8480 | MT |
NPI | 1063510220 |
---|---|
Provider Name | Janet Lynn Otto |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | St George, UT 84790-2123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000016981 | BCBS PIN (01) | MT |
0011832 | MDCD PIN (01) | MT |
113637200 | MDCD PIN (01) | WY |
314480 | BCBS PIN (01) | MT |
719212 | (05) | AZ |
G77924 | (02) | MT |