Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP0474 | MN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | CNP0474 | MN |
NPI | 1093822488 |
---|---|
Provider Name | Mr. Duane H Otten |
First Address | Edina, MN 55436-1611 |
Second Address | Coon Rapids, MN 55433-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 17/03/2018 |