Provider Demographics
NPI:1851996235
Name:SCOTT, LAURETTA YVETTE
Entity Type:Individual
Prefix:
First Name:LAURETTA
Middle Name:YVETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102A RIBBON CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005-1939
Mailing Address - Country:US
Mailing Address - Phone:443-910-4795
Mailing Address - Fax:
Practice Address - Street 1:6102A RIBBON CT
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-1939
Practice Address - Country:US
Practice Address - Phone:443-910-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDZ4Z3T5L7246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1851998235Medicaid