Basic Information
| Provider Information | |||||||||
| NPI: | 1689140790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTEBELE | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | DNP, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34509 9TH AVE S STE 304 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539391230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 34509 9TH AVE S STE 304 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539391230 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2018 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60868258 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | AP60868258 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LG0600X | AP60868258 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 1689140790 | 05 | WA | MEDICAID | 2119381 | 05 | WA | MEDICAID |