Provider Demographics
NPI:1740614882
Name:SCOTT, ANDREA J
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
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 1:20402 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3636
Mailing Address - Country:US
Mailing Address - Phone:623-445-4952
Mailing Address - Fax:623-445-5083
Practice Address - Street 1:4701 W GROVERS AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3460
Practice Address - Country:US
Practice Address - Phone:602-467-5711
Practice Address - Fax:602-467-5780
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP047340164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse