Healthcare Provider Details

I. General information

NPI: 1285312637
Provider Name (Legal Business Name): HOLLY SCOTT IBCLC, RNC-OB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10775 MCKINLEY HWY STE C
OSCEOLA IN
46561-9164
US

IV. Provider business mailing address

10775 MCKINLEY HWY STE C
OSCEOLA IN
46561-9164
US

V. Phone/Fax

Practice location:
  • Phone: 574-334-7294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-99566
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: