Provider Demographics
NPI:1326511239
Name:OTTERLEI, JULIA MARTIN (NP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARTIN
Last Name:OTTERLEI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MARTIN
Other - Last Name:WENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1005 COUGAR ST.
Mailing Address - Street 2:
Mailing Address - City:VERNONIA
Mailing Address - State:OR
Mailing Address - Zip Code:97064
Mailing Address - Country:US
Mailing Address - Phone:503-310-2075
Mailing Address - Fax:
Practice Address - Street 1:1005 COUGAR ST.
Practice Address - Street 2:
Practice Address - City:VERNONIA
Practice Address - State:OR
Practice Address - Zip Code:97064
Practice Address - Country:US
Practice Address - Phone:503-429-1953
Practice Address - Fax:503-429-1956
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201811499NP-PP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily