MEDICARE: MR. SCOTT GILMAN PMHNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	268597	AZ

General Provider Information

NPI Number	:	1700547353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT GILMAN PMHNP

Provider Business Mailing Address
First Line	:	19172 N 93RD WAY
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-5526
Country	:	US
Telephone Number	:	480-244-6071
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5309
Country	:	US
Telephone Number	:	602-604-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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