Healthcare Provider Details

I. General information

NPI: 1033703178
Provider Name (Legal Business Name): NICOLE SCOTT WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E OSBORN RD STE 250
PHOENIX AZ
85014-5699
US

IV. Provider business mailing address

8571 W CINNABAR AVE
PEORIA AZ
85345-3151
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-9161
  • Fax:
Mailing address:
  • Phone: 661-964-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number210486
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number300876
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: