Provider Demographics
NPI:1578271565
Name:SCOTT, MARILYN RENI
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:RENI
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 1:10201 S 51ST ST STE 125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5226
Mailing Address - Country:US
Mailing Address - Phone:602-549-7397
Mailing Address - Fax:602-742-2793
Practice Address - Street 1:10201 S 51ST ST STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5226
Practice Address - Country:US
Practice Address - Phone:602-549-7397
Practice Address - Fax:602-742-2793
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN109495163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management