Provider Demographics
NPI:1194941302
Name:GREGORY, SCOTT (RN)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:GREGORY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-2061
Mailing Address - Country:US
Mailing Address - Phone:559-664-4000
Mailing Address - Fax:
Practice Address - Street 1:344 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3631
Practice Address - Country:US
Practice Address - Phone:559-664-4000
Practice Address - Fax:559-675-5224
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529574163W00000X, 163WA2000X, 163WC0400X, 163WC1500X, 163WE0003X, 163WG0000X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WE0003XNursing Service ProvidersRegistered NurseEmergency
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA529574OtherRN LICENSE