Tijunae Diane Otterbridge

Primary specialty

Nurse's AideTaxonomy code 376K00000X

License

MI000059116 Issued in MI

Practice address

4218 Burton St SE
Grand Rapids, MI 49546-6121

Phone

(616) 940-0040

NPI assigned

Dec 4, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1861208951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4218 BURTON ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466121",
            "telephone_number": "616-940-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4218 BURTON ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466121",
            "telephone_number": "616-940-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTERBRIDGE",
        "first_name": "TIJUNAE",
        "middle_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "MI",
            "license": "MI000059116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Ruth Otten
• Todd Richmond Otten, M.D.
• Hillary Maxine Ottenbaker, FNP-C
• Steven Ottenweller, MD
• John Robert Otterbacher, PH.D-CLINICAL PSYCH
• Natasha Otterness, SLP
• Alexis Kathryn Otto, PA-C
• Emma Grace Ouellette
• Teresa Ouendag
• Thomas Oumedian

• Nurse's Aide in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Nurse's Aide in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.