MEDICARE: EBONY Y. 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	164W00000X	Licensed Practical Nurse	LPN.163458.MEDS-IV	OH

General Provider Information

NPI Number	:	1952930943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY Y. SCOTT

Provider Business Mailing Address
First Line	:	631 GLENDORA AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1964
Country	:	US
Telephone Number	:	330-592-8748
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 GLENDORA AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1964
Country	:	US
Telephone Number	:	330-592-8748
Fax Number	:

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

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/02/2020

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Directions to “ EBONY Y. SCOTT ” Practice Location

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