Provider Demographics
NPI:1366773640
Name:OTTO, MICHELLE W (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:W
Last Name:OTTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8613
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:
Practice Address - Street 1:545 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3914
Practice Address - Country:US
Practice Address - Phone:540-829-4352
Practice Address - Fax:540-829-4260
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004635363LA2200X
VA0024171582363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health