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NPI Code Detail

MEDICARE: KIRSTEN LORRAINE SCOTT AGCNS-BC

MEDICARE: KIRSTEN LORRAINE SCOTT AGCNS-BC
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
1364SE0003XEmergency Clinical Nurse Specialist4704318996MI

General Provider Information

NPI Number : 1669148565
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN LORRAINE SCOTT AGCNS-BC
Provider Business Mailing Address
First Line : 4432 TOWNLINE RD NW
Second Line :
City : WILLIAMSBURG
State : MI
Zip : 49690-9651
Country : US
Telephone Number : 269-348-5880
Fax Number :
Provider Business Practice Location Address
First Line : 1105 6TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2386
Country : US
Telephone Number : 231-392-0143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2021
Last Update Date : 08/19/2021

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