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General NPI Number Information
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NPI Number | 1508403767
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Entity Type | Individual
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Provider Name | RENIA SCOTT
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Gender | Female
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 5211 BERKSHIRE ST
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City | DETROIT
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State | MI
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Zip | 48224
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Country | US
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Telephone | 313-421-4130
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 BERKSHIRE ST
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City | DETROIT
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State | MI
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Zip | 48224-3205
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Country | US
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Telephone | 313-421-4130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703058673
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License Number State | MI
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