Provider Demographics
NPI:1689831786
Name:SCANLON, VIVIAN HON WEI (CRNP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:HON WEI
Last Name:SCANLON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:HON WEI
Other - Last Name:YUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:410-224-1133
Mailing Address - Fax:410-266-1639
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 635
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-224-1133
Practice Address - Fax:410-266-1639
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189122363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD315002000Medicaid
319189Y5ZMedicare PIN