Healthcare Provider Details

I. General information

NPI: 1366673089
Provider Name (Legal Business Name): BRENDA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8404 MANUEL CIA PL NE
ALBUQUERQUE NM
87122-2813
US

IV. Provider business mailing address

8404 MANUEL CIA PL NE
ALBUQUERQUE NM
87122-2813
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-0366
  • Fax:
Mailing address:
  • Phone: 505-797-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR54435
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: