Provider Demographics
NPI:1518258052
Name:SCOTT, MAUREEN MOORE (ANP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:MOORE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8371
Mailing Address - Country:US
Mailing Address - Phone:704-542-2191
Mailing Address - Fax:704-542-4243
Practice Address - Street 1:7108 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8371
Practice Address - Country:US
Practice Address - Phone:704-542-2191
Practice Address - Fax:704-542-4243
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900066363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care