Healthcare Provider Details

I. General information

NPI: 1063523470
Provider Name (Legal Business Name): SCOTT WAYNE PERRENOD DNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 TAHOE BLVD STE 51
INCLINE VILLAGE NV
89451-9408
US

IV. Provider business mailing address

330 CAPE HORN RD E
COLFAX CA
95713-9434
US

V. Phone/Fax

Practice location:
  • Phone: 775-264-6876
  • Fax:
Mailing address:
  • Phone: 889-662-3988
  • Fax: 889-662-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP12667
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP12667
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP12667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: