Provider Demographics
NPI:1518567676
Name:SCOPTUR, CAROLYN MCNALLY (BSN, MSN, APNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MCNALLY
Last Name:SCOPTUR
Suffix:
Gender:F
Credentials:BSN, MSN, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2979
Mailing Address - Fax:414-266-1616
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2979
Practice Address - Fax:414-266-1616
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10492-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics