Healthcare Provider Details

I. General information

NPI: 1992630974
Provider Name (Legal Business Name): MARY MICHELLE SCOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15127 N 172ND DR
SURPRISE AZ
85388-7820
US

IV. Provider business mailing address

15127 N 172ND DR
SURPRISE AZ
85388-7820
US

V. Phone/Fax

Practice location:
  • Phone: 520-440-3514
  • Fax: 520-440-3514
Mailing address:
  • Phone: 520-440-3514
  • Fax: 520-440-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN069299
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: