Provider Demographics
NPI:1366514267
Name:SCOTT, JEANINE ANN (CRNFA)
Entity type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 LAURELRIDGE LOOP NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7214
Mailing Address - Country:US
Mailing Address - Phone:503-510-9252
Mailing Address - Fax:
Practice Address - Street 1:7315 LAURELRIDGE LOOP NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-7214
Practice Address - Country:US
Practice Address - Phone:503-510-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079011458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse