Healthcare Provider Details

I. General information

NPI: 1346037868
Provider Name (Legal Business Name): MARY C SCOTT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 W PLUMB LN
RENO NV
89509-3793
US

IV. Provider business mailing address

2000 REGENT ST
RENO NV
89509-3132
US

V. Phone/Fax

Practice location:
  • Phone: 775-453-4628
  • Fax:
Mailing address:
  • Phone: 775-315-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number21586
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: