Provider Demographics
NPI:1508044645
Name:VAN SCOTTER, LINDA KAY (BSN, RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:VAN SCOTTER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MAIN ST UNIT 402
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5070
Mailing Address - Country:US
Mailing Address - Phone:262-613-0003
Mailing Address - Fax:262-522-0328
Practice Address - Street 1:100 E MAIN ST UNIT 402
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5070
Practice Address - Country:US
Practice Address - Phone:262-613-0003
Practice Address - Fax:262-522-0328
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0074720-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39893100Medicaid