Provider Demographics
NPI:1508892837
Name:OTTEN, JULIE ANNE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:OTTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31009
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-0009
Mailing Address - Country:US
Mailing Address - Phone:402-554-1210
Mailing Address - Fax:402-553-7232
Practice Address - Street 1:2132 S 42ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2910
Practice Address - Country:US
Practice Address - Phone:402-558-1858
Practice Address - Fax:402-558-8970
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE172642084P0800X
IA268982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1059105Medicaid
NE88089Medicare ID - Type Unspecified
IA1059105Medicaid
E28297Medicare UPIN