Provider Demographics
NPI:1346931953
Name:SCOTT, SHARI LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LYNN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:LYNN
Other - Last Name:KSOBIECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1748 HERITAGE CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9855
Mailing Address - Country:US
Mailing Address - Phone:919-899-0481
Mailing Address - Fax:
Practice Address - Street 1:1748 HERITAGE CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9855
Practice Address - Country:US
Practice Address - Phone:919-899-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018130363LP0808X
WI157172163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse