Provider Demographics
NPI:1013386994
Name:OTTE, LINDSAY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:OTTE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-4201
Mailing Address - Fax:612-273-4551
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-4201
Practice Address - Fax:612-273-4551
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN203184363LA2100X
NC282690363LA2100X
MN240540-9363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3496Medicaid
NC1013386994Medicaid
NCNCQ426CMedicare PIN
NC1013386994Medicaid
NCNCQ426BMedicare PIN
NCNCQ426AMedicare PIN