MEDICARE: MS. BONNIE SUE SCOTT FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024164374	VA

General Provider Information

NPI Number	:	1083680219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONNIE SUE SCOTT FNP-C

Provider Business Mailing Address
First Line	:	1035 NIDER BLVD SUITE 100
Second Line	:	JEB LITTLE CREEK FORT STORY
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23459-3512
Country	:	US
Telephone Number	:	757-953-8365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 NIDER BLVD SUITE 199
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23459-2731
Country	:	US
Telephone Number	:	757-953-8365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/27/2015

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