Provider Demographics
NPI:1477503126
Name:OTT, MONA LISA (CNM)
Entity type:Individual
Prefix:
First Name:MONA LISA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 STRAWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1760
Mailing Address - Country:US
Mailing Address - Phone:713-628-9906
Mailing Address - Fax:713-472-5525
Practice Address - Street 1:3210 STRAWBERRY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1760
Practice Address - Country:US
Practice Address - Phone:713-628-9906
Practice Address - Fax:713-472-5525
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241932367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP62884Medicare UPIN