Provider Demographics
NPI:1396978276
Name:SCOTT, CARESSA LATIA (LPN)
Entity type:Individual
Prefix:
First Name:CARESSA
Middle Name:LATIA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 W SUNBURY CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4850
Mailing Address - Country:US
Mailing Address - Phone:414-550-9041
Mailing Address - Fax:
Practice Address - Street 1:2302 W SUNBURY CT
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4850
Practice Address - Country:US
Practice Address - Phone:414-550-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306916031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse