Provider Demographics
NPI:1790594760
Name:SCARLATO, COURTNEY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SCARLATO
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 1:212 W TROY ST STE B
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4455
Mailing Address - Country:US
Mailing Address - Phone:304-777-6018
Mailing Address - Fax:
Practice Address - Street 1:128 AUTUMN BRANCH DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-6936
Practice Address - Country:US
Practice Address - Phone:304-777-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL-315690163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant