Provider Demographics
NPI:1558077602
Name:SCOTT, JENNIFER L (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6179 NEW CITY RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-6153
Mailing Address - Country:US
Mailing Address - Phone:217-801-0808
Mailing Address - Fax:
Practice Address - Street 1:6179 NEW CITY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-6153
Practice Address - Country:US
Practice Address - Phone:217-801-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026390363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care