Healthcare Provider Details

I. General information

NPI: 1386601151
Provider Name (Legal Business Name): BETHANY T SCOTT PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 W VILLARD AVE STE 311
MILWAUKEE WI
53209
US

IV. Provider business mailing address

W227N6103 SUSSEX RD
SUSSEX WI
53089-3969
US

V. Phone/Fax

Practice location:
  • Phone: 414-466-2424
  • Fax: 414-466-2090
Mailing address:
  • Phone: 414-566-8000
  • Fax: 414-291-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2514033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: