=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699759100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN LILLIAN SCOTT ANP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2005
-----------------------------------------------------
Last Update Date | 08/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1511 WASHINGTON ST SUITE 7
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-9314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-681-4367
-----------------------------------------------------
Fax | 315-405-4585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1511 WASHINGTON ST SUITE 7
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-9314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-681-4367
-----------------------------------------------------
Fax | 315-405-4585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F302341
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | F381241
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------