Provider Demographics
NPI:1518225416
Name:OTTER, ADA (DNP, ARNP)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:OTTER
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 214TH ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4412
Mailing Address - Country:US
Mailing Address - Phone:425-412-7200
Mailing Address - Fax:
Practice Address - Street 1:1909 214TH ST SE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4412
Practice Address - Country:US
Practice Address - Phone:425-412-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60192201363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care