Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN1022763 | DC |
Y | 363LA2200X | Nurse Practitioner - Adult Health | R155920 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R155920 | MD |
NPI | 1083956437 |
---|---|
Provider Name | Ms. June Latisha-Ann Ottley |
First Address | Laurel, MD 20724-6133 |
Second Address | Baltimore, MD 21224-5238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 25/03/2013 |