Provider Demographics
NPI:1952067936
Name:OTTO, MORGAN E (APRN)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:E
Last Name:OTTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 SNYDER CHURCH RD NW
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2316
Practice Address - Country:US
Practice Address - Phone:614-920-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily