Healthcare Provider Details

I. General information

NPI: 1437629235
Provider Name (Legal Business Name): ELIZABETH SCOTT CRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60405 E 252 LN
GROVE OK
74344-7786
US

IV. Provider business mailing address

60405 E 252 LN
GROVE OK
74344-7786
US

V. Phone/Fax

Practice location:
  • Phone: 918-801-3495
  • Fax:
Mailing address:
  • Phone: 918-801-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: