Provider Demographics
NPI:1194896753
Name:VANDAWALKER, SCOTT G (NP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:VANDAWALKER
Suffix:
Gender:M
Credentials:NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6455 S YOSEMITE ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5139
Mailing Address - Country:US
Mailing Address - Phone:303-652-7468
Mailing Address - Fax:855-307-6951
Practice Address - Street 1:6455 S YOSEMITE ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5139
Practice Address - Country:US
Practice Address - Phone:303-652-7468
Practice Address - Fax:855-307-6951
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO86563163W00000X
COAPN.0003114-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98001574Medicaid
CO98001574Medicaid