Healthcare Provider Details

I. General information

NPI: 1134940083
Provider Name (Legal Business Name): CHARLOTTE RUTH SCOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 WILSON CREEK RD
NEWARK VALLEY NY
13811-2601
US

IV. Provider business mailing address

68 WILSON CREEK RD
NEWARK VALLEY NY
13811-2601
US

V. Phone/Fax

Practice location:
  • Phone: 607-642-8665
  • Fax:
Mailing address:
  • Phone: 607-642-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number701921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: