MEDICARE: BRENDA SCOTT

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	163WP2201X	Ambulatory Care Registered Nurse	R54435	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R54435	OTHER	NM	RN LICENSE

General Provider Information

NPI Number	:	1366673089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA SCOTT

Provider Business Mailing Address
First Line	:	8404 MANUEL CIA PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-2813
Country	:	US
Telephone Number	:	505-797-0366
Fax Number	:

Provider Business Practice Location Address
First Line	:	8404 MANUEL CIA PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-2813
Country	:	US
Telephone Number	:	505-797-0366
Fax Number	:

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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Directions to “ BRENDA SCOTT ” Practice Location

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