Provider Demographics
NPI:1477064335
Name:OTOO, JOSEPHINE R (APRN)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:R
Last Name:OTOO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JOSEPHINE
Other - Middle Name:R
Other - Last Name:OTOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2113 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8155
Mailing Address - Country:US
Mailing Address - Phone:405-301-6806
Mailing Address - Fax:
Practice Address - Street 1:2400 N HEMLOCK CIR STE B
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1175
Practice Address - Country:US
Practice Address - Phone:918-259-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily