Healthcare Provider Details

I. General information

NPI: 1740648302
Provider Name (Legal Business Name): MEGAN SCOTT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159A ASPEN RD
JUNE LAKE CA
93529
US

IV. Provider business mailing address

PO BOX 194
JUNE LAKE CA
93529-0194
US

V. Phone/Fax

Practice location:
  • Phone: 760-258-7662
  • Fax:
Mailing address:
  • Phone: 760-258-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-87198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number702515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: