MEDICARE: MR. SCOTT CHARLES DALRYMPLE RN

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	163W00000X	Registered Nurse	644213	CA
2	163W00000X	Registered Nurse	RN61079235	WA

General Provider Information

NPI Number	:	1366621245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT CHARLES DALRYMPLE RN

Provider Business Mailing Address
First Line	:	107 S DIVISION ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-1510
Country	:	US
Telephone Number	:	415-755-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 N CALISPEL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2317
Country	:	US
Telephone Number	:	509-838-4651
Fax Number	:

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

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	08/20/2021

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