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General NPI Number Information
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NPI Number | 1679180244
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Entity Type | Individual
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Provider Name | LAURA LEE SCOTT NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1547 MIDWAY AVE SUITE B
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City | AMMON
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State | ID
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Zip | 83406-6912
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Country | US
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Telephone | 208-497-0429
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Fax | 208-497-0430
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Provider Business Mailing Address
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Address Line | 5294 FREE AVE
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City | IONA
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State | ID
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Zip | 83427-4912
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Country | US
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Telephone | 208-680-4915
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 66030
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 50162
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License Number State | ID
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