Provider Demographics
NPI:1275521692
Name:OTREMBA, JAMIE (CNM)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:OTREMBA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1763
Mailing Address - Country:US
Mailing Address - Phone:952-442-2137
Mailing Address - Fax:952-442-5960
Practice Address - Street 1:550 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1763
Practice Address - Country:US
Practice Address - Phone:952-442-2137
Practice Address - Fax:952-442-5960
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR131949-9176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN507488600Medicaid
MN4200000358Medicare ID - Type Unspecified
MNP47473Medicare UPIN