Provider Demographics
NPI:1821075425
Name:SCOTT, COURTNEY L
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:6490 EXCELSIOR BLVD # E500
Practice Address - Street 2:PARK NICOLLET CLINIC - MEADOWBROOK
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-993-7342
Practice Address - Fax:952-993-2701
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2016-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant