Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | IL | |
N | 1223G0001X | General Practice | IL | |
N | 213EG0000X | General Practice | IL |
NPI | 1205965548 |
---|---|
Provider Name | Dr. Patricia Annette Scott |
First Address | Urbana, IL 61802-2280 |
Second Address | Urbana, IL 61802-2280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003669 | (05) | IL |
101248 | (05) | IL |