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NPI Code Detail

MEDICARE: NINA D SCOTT NP

MEDICARE: NINA D SCOTT NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse28104970IN
2363L00000XNurse Practitioner71000026IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1500005028OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497730535
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA D SCOTT NP
Provider Business Mailing Address
First Line : 3512 STELLHORN RD
Second Line : SUITE 100
City : FORT WAYNE
State : IN
Zip : 46815-4631
Country : US
Telephone Number : 260-483-9081
Fax Number : 260-483-9196
Provider Business Practice Location Address
First Line : 3512 STELLHORN RD
Second Line : SUITE 100
City : FORT WAYNE
State : IN
Zip : 46815-4631
Country : US
Telephone Number : 260-483-9081
Fax Number : 260-483-9196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 03/21/2017

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