Provider Demographics
NPI:1952935512
Name:OTTOMEYER, LEANN ROSE (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:ROSE
Last Name:OTTOMEYER
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4498 ROSEMARY WAY UNIT 6
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-6013
Mailing Address - Country:US
Mailing Address - Phone:651-226-8438
Mailing Address - Fax:
Practice Address - Street 1:168 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-4401
Practice Address - Country:US
Practice Address - Phone:651-226-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily