Provider Demographics
NPI:1740648302
Name:SCOTT, MEGAN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:JUNE LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93529-0194
Mailing Address - Country:US
Mailing Address - Phone:760-258-7662
Mailing Address - Fax:
Practice Address - Street 1:159A ASPEN RD
Practice Address - Street 2:
Practice Address - City:JUNE LAKE
Practice Address - State:CA
Practice Address - Zip Code:93529
Practice Address - Country:US
Practice Address - Phone:760-258-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-87198163WL0100X
CA702515163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn