Healthcare Provider Details

I. General information

NPI: 1164749263
Provider Name (Legal Business Name): LITA A SCOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

IV. Provider business mailing address

PO BOX 3630
FLAGSTAFF AZ
86003-3630
US

V. Phone/Fax

Practice location:
  • Phone: 928-213-6100
  • Fax:
Mailing address:
  • Phone: 928-213-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3632
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: