Healthcare Provider Details

I. General information

NPI: 1326497249
Provider Name (Legal Business Name): NICOLE SCOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 S LIMESTONE ST
SPRINGFIELD OH
45505-1965
US

IV. Provider business mailing address

122 WYOMING ST
DAYTON OH
45409-2731
US

V. Phone/Fax

Practice location:
  • Phone: 937-324-1111
  • Fax: 937-525-4541
Mailing address:
  • Phone: 937-223-4461
  • Fax: 937-449-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.19210-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: