Provider Demographics
NPI:1568004778
Name:SCOTT, STACY LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7368 MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9299
Mailing Address - Country:US
Mailing Address - Phone:734-340-7987
Mailing Address - Fax:313-334-3516
Practice Address - Street 1:7368 MERIDIAN DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9299
Practice Address - Country:US
Practice Address - Phone:734-340-7987
Practice Address - Fax:313-334-3516
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704274158163WC0400X, 163WA0400X, 163WC1500X, 163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health