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1104061589 NPI number — AUDREY SHERON SCOTT NURSE PRACTITIONER

NPI Number: 1104061589
Health Care Provider/Practitioner: AUDREY SHERON SCOTT NURSE PRACTITIONER

Information about “1104061589” NPI (AUDREY SHERON SCOTT NURSE PRACTITIONER) exists in 1104061589 in HTML format HTML  |  1104061589 in plain Text format TXT  |  1104061589 in PDF (Portable Document Format) PDF  |  1104061589 in an XML format XML  formats.

NPI Number : 1104061589 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104061589",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SCOTT",
    "FirstName": "AUDREY",
    "MiddleName": "SHERON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2045 MEYER PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COSTA MESA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92627-2967",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "949-515-6725",
    "MailingAddressFaxNumber": "949-515-6726",
    "FirstLinePracticeLocationAddress": "2045 MEYER PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COSTA MESA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92627-2967",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "949-515-6725",
    "PracticeLocationAddressFaxNumber": "949-515-6726",
    "EnumerationDate": "12/12/2008",
    "LastUpdateDate": "12/12/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "364SF0001X",
        "TaxonomyName": "Family Health Clinical Nurse Specialist",
        "LicenseNumber": "423748",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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