Provider Demographics
NPI:1093207854
Name:NICOLE L SCOTT NP C ADULT PRIMARY CARE LLC
Entity type:Organization
Organization Name:NICOLE L SCOTT NP C ADULT PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NP C
Authorized Official - Phone:302-502-2959
Mailing Address - Street 1:410 FOULK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3835
Mailing Address - Country:US
Mailing Address - Phone:302-502-2959
Mailing Address - Fax:302-762-5361
Practice Address - Street 1:410 FOULK RD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3835
Practice Address - Country:US
Practice Address - Phone:302-502-2959
Practice Address - Fax:302-762-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELB-0000198363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty