Healthcare Provider Details

I. General information

NPI: 1346624459
Provider Name (Legal Business Name): SCOTT E WILSON F.N.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 W RUTTER PKWY
SPOKANE WA
99208-9210
US

IV. Provider business mailing address

9106 W RUTTER PKWY
SPOKANE WA
99208-9210
US

V. Phone/Fax

Practice location:
  • Phone: 360-880-8193
  • Fax:
Mailing address:
  • Phone: 360-880-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70109780
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201603114
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: