Healthcare Provider Details

I. General information

NPI: 1801478581
Provider Name (Legal Business Name): MIA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 SCOTT BLVD
BOWLING GREEN OH
43402-2622
US

IV. Provider business mailing address

9802 DOWLING RD
PERRYSBURG OH
43551-9330
US

V. Phone/Fax

Practice location:
  • Phone: 419-410-6439
  • Fax: 419-710-5382
Mailing address:
  • Phone: 419-410-6439
  • Fax: 855-933-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: