1538845870 NPI number — EMILIE ELSA SCOTT CNA

Table of content: EMILIE ELSA SCOTT CNA (NPI 1538845870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538845870 NPI number — EMILIE ELSA SCOTT CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
EMILIE
Provider Middle Name:
ELSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538845870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8675 SUNSET LN NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEABECK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98380-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-900-9775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 NW MYHRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-7663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-744-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X , with the licence number:  61312213 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)