Provider Demographics
NPI:1083956437
Name:OTTLEY, JUNE LATISHA-ANN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:LATISHA-ANN
Last Name:OTTLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JUNE
Other - Middle Name:LATISHA-ANN
Other - Last Name:GILPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:8044 IANS ALY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-6133
Mailing Address - Country:US
Mailing Address - Phone:240-431-1525
Mailing Address - Fax:
Practice Address - Street 1:5550 FRIENDSHIP BLVD STE 590
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7310
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:240-235-8720
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1022763363L00000X
MDR155920363LA2200X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology