Provider Demographics
NPI:1760752737
Name:PRESTON, SCOTT WILLIAM (RN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAM
Last Name:PRESTON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:WILLIAM
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3941 YATES ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2212
Mailing Address - Country:US
Mailing Address - Phone:303-949-0374
Mailing Address - Fax:
Practice Address - Street 1:3941 YATES ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2212
Practice Address - Country:US
Practice Address - Phone:303-949-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160687163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse