Provider Demographics
NPI:1144033507
Name:OTTERSBERG, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:OTTERSBERG
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 1:3116 COLT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1157
Mailing Address - Country:US
Mailing Address - Phone:402-432-5245
Mailing Address - Fax:
Practice Address - Street 1:3116 COLT AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-1157
Practice Address - Country:US
Practice Address - Phone:402-432-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion