Healthcare Provider Details

I. General information

NPI: 1093207854
Provider Name (Legal Business Name): NICOLE L SCOTT NP C ADULT PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 FOULK RD STE 100
WILMINGTON DE
19803-3835
US

IV. Provider business mailing address

410 FOULK RD STE 100
WILMINGTON DE
19803-3835
US

V. Phone/Fax

Practice location:
  • Phone: 302-502-2959
  • Fax: 302-762-5361
Mailing address:
  • Phone: 302-502-2959
  • Fax: 302-762-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLB-0000198
License Number StateDE

VIII. Authorized Official

Name: NICOLE L SCOTT
Title or Position: OWNER
Credential: NP C
Phone: 302-502-2959