Healthcare Provider Details

I. General information

NPI: 1649398140
Provider Name (Legal Business Name): ELLEN SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 MARATHON CIR
ANCHORAGE AK
99515-2421
US

IV. Provider business mailing address

3161 MARATHON CIR
ANCHORAGE AK
99515-2421
US

V. Phone/Fax

Practice location:
  • Phone: 907-243-4394
  • Fax: 907-243-4774
Mailing address:
  • Phone: 907-243-4394
  • Fax: 907-243-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberBUSINESS # 414489
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: