Provider Demographics
NPI:1013035377
Name:SCOTT, CHARLENE (RN, NP, PHN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RN, NP, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4513
Mailing Address - Country:US
Mailing Address - Phone:562-285-0149
Mailing Address - Fax:562-285-0156
Practice Address - Street 1:830 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4513
Practice Address - Country:US
Practice Address - Phone:562-285-0149
Practice Address - Fax:562-285-0156
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN257409163WP0809X
171M00000X, 225400000X
CA4335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner