Provider Demographics
NPI:1083905103
Name:OTTOSON, MARK CLIFTON (NP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CLIFTON
Last Name:OTTOSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:683 CUNARD DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3628
Mailing Address - Country:US
Mailing Address - Phone:707-259-1410
Mailing Address - Fax:707-963-4796
Practice Address - Street 1:1370 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1124
Practice Address - Country:US
Practice Address - Phone:707-963-4399
Practice Address - Fax:707-963-4796
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA429620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily