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NPI Code Detail

MEDICARE: STACEY SCOTT

MEDICARE: STACEY 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
1175T00000XPeer SpecialistNE

General Provider Information

NPI Number : 1548775075
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY SCOTT
Provider Business Mailing Address
First Line : 910 W PARK AVE
Second Line :
City : NORFOLK
State : NE
Zip : 68701-5044
Country : US
Telephone Number : 402-379-3622
Fax Number :
Provider Business Practice Location Address
First Line : 910 W PARK AVE
Second Line :
City : NORFOLK
State : NE
Zip : 68701-5044
Country : US
Telephone Number : 402-379-3622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2017
Last Update Date : 12/06/2017

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Directions to “ STACEY SCOTT ” Practice Location

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