Provider Demographics
NPI:1811462401
Name:FRYLING, SCOTT ALAN (RN)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:FRYLING
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45964 BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5410
Mailing Address - Country:US
Mailing Address - Phone:586-948-0665
Mailing Address - Fax:586-948-0667
Practice Address - Street 1:45964 BRENTWOOD ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5410
Practice Address - Country:US
Practice Address - Phone:586-948-0665
Practice Address - Fax:586-948-0667
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251955163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health