Provider Demographics
NPI:1679180244
Name:SCOTT, LAURA LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5294 FREE AVE
Mailing Address - Street 2:
Mailing Address - City:IONA
Mailing Address - State:ID
Mailing Address - Zip Code:83427-4912
Mailing Address - Country:US
Mailing Address - Phone:208-680-4915
Mailing Address - Fax:
Practice Address - Street 1:1547 MIDWAY AVE SUITE B
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6912
Practice Address - Country:US
Practice Address - Phone:208-497-0429
Practice Address - Fax:208-497-0430
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID50162163W00000X
ID66030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse