Provider Demographics
NPI:1467189878
Name:PITTEL, SCOTT ANDREW
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:PITTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8477 GOLDFINCH DR
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8694
Mailing Address - Country:US
Mailing Address - Phone:989-326-1757
Mailing Address - Fax:
Practice Address - Street 1:8477 GOLDFINCH DR
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8694
Practice Address - Country:US
Practice Address - Phone:989-326-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704280762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner