Provider Demographics
NPI:1285675843
Name:SCOTT, LAURA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 ORCHARD DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6187
Mailing Address - Country:US
Mailing Address - Phone:989-631-6710
Mailing Address - Fax:989-631-8583
Practice Address - Street 1:4007 ORCHARD DR
Practice Address - Street 2:SUTIE 2003
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6187
Practice Address - Country:US
Practice Address - Phone:989-631-6710
Practice Address - Fax:989-631-8583
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG004143363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N8230001Medicare ID - Type Unspecified
MIN82300001Medicare UPIN
Q04147Medicare UPIN