Provider Demographics
NPI:1043190416
Name:OTASOWIE, JOSEPHINE IREDIA
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:IREDIA
Last Name:OTASOWIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 RUSTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2930
Mailing Address - Country:US
Mailing Address - Phone:443-559-7075
Mailing Address - Fax:
Practice Address - Street 1:1215 RUSTIC AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2930
Practice Address - Country:US
Practice Address - Phone:443-559-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR251963363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health