Provider Demographics
NPI:1073647764
Name:SCOTT, MARY LOU (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOU
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SCIOTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5404
Mailing Address - Country:US
Mailing Address - Phone:740-776-6314
Mailing Address - Fax:
Practice Address - Street 1:5626 3RD ST
Practice Address - Street 2:
Practice Address - City:SCIOTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45662-5404
Practice Address - Country:US
Practice Address - Phone:740-776-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122333164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH112333OtherLICENSED PRACTICAL NURSE
OH2617903OtherINDEPENDENT PROVIDER