Provider Demographics
NPI:1740579028
Name:OTTO, SANDRA LEE (CNP)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:LEE
Last Name:OTTO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACNP
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:J4-134
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-2200
Mailing Address - Fax:216-445-3117
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:J4-134
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:216-445-3117
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12283-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care