Basic Information
| Provider Information | |||||||||
| NPI: | 1750355798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OTT | ||||||||
| FirstName: | STEFANIE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5520 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180150520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109545810 | ||||||||
| FaxNumber: | 6109545490 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 OSTRUM ST | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109545810 | ||||||||
| FaxNumber: | 6109545480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN-538722 | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 073904 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2626490000 | 01 | PA | IBC | OTHER | 97452 | 01 | PA | GEISINGER | OTHER | 1789399 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1550240 | 01 | PA | GATEWAY | OTHER | 1789399 | 01 | PA | FIRST PRIORITY | OTHER | 11754805 | 01 | PA | CAQH | OTHER | 9426441 | 01 | PA | AETNA | OTHER | 1023332060003 | 05 | PA | MEDICAID | 50055232 | 01 | PA | CAPITAL ADVANTAGE | OTHER |