Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | ||
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4335 | CA |
NPI | 1013035377 |
---|---|
Provider Name | Mrs. Charlene Scott |
First Address | Long Beach, CA 90813-4513 |
Second Address | Long Beach, CA 90813-4513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 05/06/2013 |