Provider Demographics
NPI:1154492650
Name:SCOTT, TAMARA E (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:E
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 N GANTENBEIN AVE
Mailing Address - Street 2:SUITE 4247
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1623
Mailing Address - Country:US
Mailing Address - Phone:503-413-4987
Mailing Address - Fax:503-413-2879
Practice Address - Street 1:2801 N. GANTENBEIN AVE
Practice Address - Street 2:SUITE 4247
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-413-4987
Practice Address - Fax:503-413-2897
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404449163W00000X
OR201394418RN163WP0200X
CA3085363LP0200X
OR201394419NP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP17591Medicare UPIN