Basic Information
| Provider Information | |||||||||
| NPI: | 1699328088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | ANGELIQUE | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 573 MERRIMON AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288043490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282511478 | ||||||||
| FaxNumber: | 8282515227 | ||||||||
| Practice Location | |||||||||
| Address1: | 573 MERRIMON AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288043490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282511478 | ||||||||
| FaxNumber: | 8282515227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2019 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 83409 | NC | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.