Provider Demographics
NPI:1902410657
Name:SCOTT, JAMIE GERALDINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:GERALDINE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:GERALDINE
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290293 COUNTY ROAD G
Mailing Address - Street 2:
Mailing Address - City:MINATARE
Mailing Address - State:NE
Mailing Address - Zip Code:69356-4327
Mailing Address - Country:US
Mailing Address - Phone:308-225-3398
Mailing Address - Fax:
Practice Address - Street 1:1107 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MINATARE
Practice Address - State:NE
Practice Address - Zip Code:69356-3994
Practice Address - Country:US
Practice Address - Phone:308-783-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19850164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE19850OtherSTATE OF NEBRASKA DEPARTMENT OF HEALTH AND HUMN SERVICES, REGULATION AND LICENSU