Provider Demographics
NPI:1104368836
Name:LINSCOTT, MARY (LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LINSCOTT
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 1:2628 YALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-3913
Mailing Address - Country:US
Mailing Address - Phone:217-416-3485
Mailing Address - Fax:
Practice Address - Street 1:3220 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6215
Practice Address - Country:US
Practice Address - Phone:217-544-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043-047623164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse