Provider Demographics
NPI:1518132166
Name:SCOTT, JUDITH LYNNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MORICHES MIDDLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967
Mailing Address - Country:US
Mailing Address - Phone:631-345-0245
Mailing Address - Fax:
Practice Address - Street 1:14 MORICHES MIDDLE ISL RD
Practice Address - Street 2:
Practice Address - City:NORTH SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967
Practice Address - Country:US
Practice Address - Phone:631-345-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2297771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140545Medicaid