Provider Demographics
NPI:1043644768
Name:SCOTT, ABBIE NICHOLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:NICHOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HERITAGE PL
Mailing Address - Street 2:APT 113
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6068
Mailing Address - Country:US
Mailing Address - Phone:515-975-5707
Mailing Address - Fax:
Practice Address - Street 1:576 BIELENBERG DR
Practice Address - Street 2:SUITE 250
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1734
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:651-348-3355
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered