Provider Demographics
NPI:1770391633
Name:MOYER, SCOTT LOGAN
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LOGAN
Last Name:MOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 W K ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-2419
Mailing Address - Country:US
Mailing Address - Phone:308-737-0473
Mailing Address - Fax:
Practice Address - Street 1:1209 W K ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-2419
Practice Address - Country:US
Practice Address - Phone:308-737-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35617165373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist