Provider Demographics
NPI:1932508132
Name:SCOTT, TRACI L (CNM)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WATERSIDE PLZ
Mailing Address - Street 2:36-H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2602
Mailing Address - Country:US
Mailing Address - Phone:646-402-2870
Mailing Address - Fax:
Practice Address - Street 1:10 WATERSIDE PLZ
Practice Address - Street 2:36-H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2602
Practice Address - Country:US
Practice Address - Phone:646-402-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360531-1363LX0001X
NYF001614-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology