Provider Demographics
NPI:1093428724
Name:SCOTT, MICHAELA (RN)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 LOWER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9143
Mailing Address - Country:US
Mailing Address - Phone:607-423-8822
Mailing Address - Fax:
Practice Address - Street 1:322 LOWER CREEK RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9143
Practice Address - Country:US
Practice Address - Phone:607-423-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY793280163WN0002X, 163WP0200X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn