Provider Demographics
NPI:1396023206
Name:SCOTT, TASHA L (CNM)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 71757
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-0757
Mailing Address - Country:US
Mailing Address - Phone:734-224-4244
Mailing Address - Fax:313-341-0203
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:SUITE #320
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2614
Practice Address - Country:US
Practice Address - Phone:734-224-4244
Practice Address - Fax:313-341-0203
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704250363163W00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231858Medicare Oscar/Certification