Provider Demographics
NPI:1639793052
Name:SCOTT, MICHELLE D (CNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-2853
Mailing Address - Country:US
Mailing Address - Phone:319-470-6174
Mailing Address - Fax:
Practice Address - Street 1:1930 AVENUE J
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-4237
Practice Address - Country:US
Practice Address - Phone:319-470-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA311769376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
19869OtherDEPARTMENT OF LABOR