Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2015025674 | MO |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2019047655 | MO |
NPI | 1033585609 |
---|---|
Provider Name | Robert Otto |
First Address | Olathe, KS 66061-5260 |
Second Address | Olathe, KS 66061-5260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2015 |
Last Update Date | 28/02/2020 |