Provider Demographics
NPI:1144073669
Name:OTTENSTROER, ALICE NORENE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:NORENE
Last Name:OTTENSTROER
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 1:12443 90TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6540
Mailing Address - Country:US
Mailing Address - Phone:612-283-3409
Mailing Address - Fax:
Practice Address - Street 1:12443 90TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6540
Practice Address - Country:US
Practice Address - Phone:612-283-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN027816001445376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide