Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP30007080 | WA |
NPI | 1003971599 |
---|---|
Provider Name | Teri Lynae Scott |
First Address | Bremerton, WA 98310-4229 |
Second Address | Bremerton, WA 98310-4229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 22/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G8883372 | PTAN (01) | WA |
G8883373 | PTAN (01) | WA |
Q74228 | (02) | WA |