Healthcare Provider Details

I. General information

NPI: 1386551992
Provider Name (Legal Business Name): ANGELA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 W CAPITOL DR
MILWAUKEE WI
53216-2321
US

IV. Provider business mailing address

5225 W VLIET ST
MILWAUKEE WI
53208-2698
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-4816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number144542
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: