Provider Demographics
NPI:1992209910
Name:SCOTT, NICCOLE MICHELE
Entity Type:Individual
Prefix:
First Name:NICCOLE
Middle Name:MICHELE
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 1:4000 ROSE ST APT 2205
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-2083
Mailing Address - Country:US
Mailing Address - Phone:510-292-1067
Mailing Address - Fax:
Practice Address - Street 1:1640 N 44TH ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-1114
Practice Address - Country:US
Practice Address - Phone:504-309-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver