Provider Demographics
NPI:1245531284
Name:SCOTT, RAYMOND (LPN)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 LYCEUM ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-2602
Mailing Address - Country:US
Mailing Address - Phone:585-342-5262
Mailing Address - Fax:
Practice Address - Street 1:254 LYCEUM ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-2602
Practice Address - Country:US
Practice Address - Phone:585-342-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297136-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse