Healthcare Provider Details

I. General information

NPI: 1154492650
Provider Name (Legal Business Name): TAMARA E SCOTT R.N., MSN, C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N. GANTENBEIN AVE SUITE 4247
PORTLAND OR
97045
US

IV. Provider business mailing address

2801 N GANTENBEIN AVE SUITE 4247
PORTLAND OR
97227-1623
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-4987
  • Fax: 503-413-2897
Mailing address:
  • Phone: 503-413-4987
  • Fax: 503-413-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number404449
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number201394418RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3085
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201394419NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: