Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN235965 | GA |
N | 363LP2300X | Nurse Practitioner - Primary Care | RN235965 | GA |
NPI | 1033635925 |
---|---|
Provider Name | Stephanie Ottimo |
First Address | Atlanta, GA 30305-1717 |
Second Address | Atlanta, GA 30328-5579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2017 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN235965 | RN LICENSE (01) | GA |