MEDICARE: SCOTT WILLIAM PRESTON RN

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	163W00000X	Registered Nurse	160687	CO

General Provider Information

NPI Number	:	1760752737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT WILLIAM PRESTON RN

Provider Business Mailing Address
First Line	:	3941 YATES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2212
Country	:	US
Telephone Number	:	303-949-0374
Fax Number	:

Provider Business Practice Location Address
First Line	:	3941 YATES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2212
Country	:	US
Telephone Number	:	303-949-0374
Fax Number	:

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	01/09/2012

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