Provider Demographics
NPI:1558692814
Name:OTTEMA CHRISTENSEN, DIANE KAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:KAY
Last Name:OTTEMA CHRISTENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:KAY
Other - Last Name:OTTEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-0045
Mailing Address - Country:US
Mailing Address - Phone:307-941-1186
Mailing Address - Fax:
Practice Address - Street 1:420 DEANNE AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2936
Practice Address - Country:US
Practice Address - Phone:307-746-4456
Practice Address - Fax:307-746-4470
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22760163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health