Provider Demographics
NPI:1780568568
Name:OTTENS, ELLIE M (CNA, BSN STUDENT)
Entity type:Individual
Prefix:MISS
First Name:ELLIE
Middle Name:M
Last Name:OTTENS
Suffix:
Gender:F
Credentials:CNA, BSN STUDENT
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA, BSN STUDENT
Mailing Address - Street 1:6110 N 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4518
Mailing Address - Country:US
Mailing Address - Phone:402-315-0430
Mailing Address - Fax:
Practice Address - Street 1:5345 S 204TH AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4383
Practice Address - Country:US
Practice Address - Phone:402-315-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant