Provider Demographics
NPI:1003221052
Name:SCOTT, GREG (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2722 TEN CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:WI
Mailing Address - Zip Code:54459-8170
Mailing Address - Country:US
Mailing Address - Phone:715-767-5250
Mailing Address - Fax:
Practice Address - Street 1:N2722 TEN CROSSING RD
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:WI
Practice Address - Zip Code:54459-8170
Practice Address - Country:US
Practice Address - Phone:715-767-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI114407-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse