Provider Demographics
NPI:1912417197
Name:SCOTT, DAJAI DOMINIQUE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:DAJAI
Middle Name:DOMINIQUE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1 FORD PL STE 3A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:313-874-4806
Mailing Address - Fax:313-876-1305
Practice Address - Street 1:6777 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-880-5838
Practice Address - Fax:248-325-0021
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMW010755367A00000X
MI4704303559367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife