Provider Demographics
NPI:1700453651
Name:OTERO, KARISA J (RN)
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:J
Last Name:OTERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7527
Mailing Address - Country:US
Mailing Address - Phone:505-459-1122
Mailing Address - Fax:
Practice Address - Street 1:301 ALAME LOOP
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-6034
Practice Address - Country:US
Practice Address - Phone:505-966-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-79416163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool