Healthcare Provider Details

I. General information

NPI: 1285182535
Provider Name (Legal Business Name): KATHERINE BRENDA SCOTT RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29583 OLD HIGHWAY 30
CALDWELL ID
83607-8629
US

IV. Provider business mailing address

29583 OLD HIGHWAY 30
CALDWELL ID
83607-8629
US

V. Phone/Fax

Practice location:
  • Phone: 775-813-3980
  • Fax:
Mailing address:
  • Phone: 775-813-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN30291
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: