Basic Information
| Provider Information | |||||||||
| NPI: | 1194941302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGORY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 ROSE AVE | ||||||||
| Address2: | |||||||||
| City: | CHOWCHILLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936102061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596644000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 344 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936383631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596644000 | ||||||||
| FaxNumber: | 5596755224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 529574 | CA | X | Nursing Service Providers | Registered Nurse | 163WA2000X | 529574 | CA | X | Nursing Service Providers | Registered Nurse | Administrator | 163WC0400X | 529574 | CA | X | Nursing Service Providers | Registered Nurse | Case Management | 163WC1500X | 529574 | CA | X | Nursing Service Providers | Registered Nurse | Community Health | 163WE0003X | 529574 | CA | X | Nursing Service Providers | Registered Nurse | Emergency | 163WG0000X | 529574 | CA | X | Nursing Service Providers | Registered Nurse | General Practice | 163WX0106X | 529574 | CA | X | Nursing Service Providers | Registered Nurse | Occupational Health |
ID Information
| ID | Type | State | Issuer | Description | 529574 | 01 | CA | RN LICENSE | OTHER |