Provider Demographics
NPI:1417388521
Name:SCOTLAND, EMILY EILEEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:EILEEN
Last Name:SCOTLAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:S
Other - Last Name:HAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1060 EISENSCHMIDT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-3212
Mailing Address - Country:US
Mailing Address - Phone:503-366-7645
Mailing Address - Fax:503-366-7649
Practice Address - Street 1:1060 EISENSCHMIDT LN
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-3212
Practice Address - Country:US
Practice Address - Phone:503-366-7645
Practice Address - Fax:503-366-7649
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002001363LF0000X, 363L00000X
AZAP5245363LF0000X
OR201704873NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR196052OtherMEDICARE PTAN
OR500728497Medicaid