Provider Demographics
NPI:1700189081
Name:FRACUL, SCOTT (RN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FRACUL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-5409
Mailing Address - Country:US
Mailing Address - Phone:724-657-9822
Mailing Address - Fax:
Practice Address - Street 1:1015 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-5409
Practice Address - Country:US
Practice Address - Phone:724-657-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN548280367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered