Provider Demographics
NPI:1740444033
Name:LOPERA-OTTENHEIMER, MICHELLE YVONNE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVONNE
Last Name:LOPERA-OTTENHEIMER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2880 NW STEWART PKWY STE 200
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1204
Mailing Address - Country:US
Mailing Address - Phone:541-673-0496
Mailing Address - Fax:541-673-5794
Practice Address - Street 1:2880 NW STEWART PKWY STE 200
Practice Address - Street 2:SUITE 203
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1204
Practice Address - Country:US
Practice Address - Phone:541-673-0496
Practice Address - Fax:541-673-5794
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2014-04-22
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Provider Licenses
StateLicense IDTaxonomies
ORPA00810363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical