Provider Demographics
NPI:1124217948
Name:OTTO, LINDA (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1022
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:701 E DAVIS ST
Practice Address - Street 2:STE A
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-3099
Practice Address - Country:US
Practice Address - Phone:936-525-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse