Provider Demographics
NPI:1518595552
Name:SCOTT, KAREN PETERSEN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:PETERSEN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-0630
Mailing Address - Country:US
Mailing Address - Phone:707-884-3750
Mailing Address - Fax:
Practice Address - Street 1:40230 ROSEMAN CREEK RD
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-7520
Practice Address - Country:US
Practice Address - Phone:707-884-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider