| Jasmine Ottmar Pllc | |
|
6046 14th St S Fargo ND 58104-7340 | |
| (701) 404-0997 | |
| (701) 566-8876 |
| Full Name | Jasmine Ottmar Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 6046 14th St S, Fargo, North Dakota |
| Authorized Official Name and Position | Jasmine Ottmar (PRESIDENT) |
| Authorized Official Contact | 7012090319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jasmine Ottmar Pllc 6046 14th St S Fargo ND 58104-7340 Ph: (701) 209-0319 | Jasmine Ottmar Pllc 6046 14th St S Fargo ND 58104-7340 Ph: (701) 404-0997 |
| NPI Number | 1235720574 |
|---|---|
| Provider Enumeration Date | 01/29/2021 |
| Last Update Date | 10/05/2021 |
| Certification Date | 10/05/2021 |
| Medicare PECOS PAC ID | 8628487816 |
|---|---|
| Medicare Enrollment ID | O20210428002421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235720574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jasmine Ottmar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942579966 PECOS PAC ID: 2668804865 Enrollment ID: I20200221002493 |
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