Healthcare Provider Details

I. General information

NPI: 1790594760
Provider Name (Legal Business Name): COURTNEY SCARLATO RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2025
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 AUTUMN BRANCH DR
MADISON AL
35757-6936
US

IV. Provider business mailing address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

V. Phone/Fax

Practice location:
  • Phone: 304-777-6018
  • Fax:
Mailing address:
  • Phone: 304-777-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-315690
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: