Provider Demographics
NPI:1790519619
Name:OTKIN, AMBER LYNN (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:OTKIN
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-2179
Mailing Address - Country:US
Mailing Address - Phone:507-215-0209
Mailing Address - Fax:
Practice Address - Street 1:1417 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1022
Practice Address - Country:US
Practice Address - Phone:605-322-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003339363LW0102X
SDCM000112176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health