Provider Demographics
NPI:1881317162
Name:SCOTT, WYETTE EVETTE (CNA)
Entity type:Individual
Prefix:
First Name:WYETTE
Middle Name:EVETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 FALCON NEST PL APT 206
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0788
Mailing Address - Country:US
Mailing Address - Phone:757-506-4286
Mailing Address - Fax:
Practice Address - Street 1:4912 FALCON NEST PL APT 206
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-0788
Practice Address - Country:US
Practice Address - Phone:757-506-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401100372376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide