Provider Demographics
NPI:1659057024
Name:NAVARRO, RICHARD SCOTT (DNP FNP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SCOTT
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:DNP FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-7453
Mailing Address - Country:US
Mailing Address - Phone:651-336-1201
Mailing Address - Fax:
Practice Address - Street 1:481 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021-7453
Practice Address - Country:US
Practice Address - Phone:651-336-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner