Healthcare Provider Details

I. General information

NPI: 1356261200
Provider Name (Legal Business Name): VICTORIA ANN SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TORI SCOTT

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LAFAYETTE AVE SE STE 301
GRAND RAPIDS MI
49503-4656
US

IV. Provider business mailing address

6688 ECHO DR NE
ROCKFORD MI
49341-9431
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704330059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: