Provider Demographics
NPI:1386601151
Name:SCOTT, BETHANY T (PNP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:T
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W227N6103 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3969
Mailing Address - Country:US
Mailing Address - Phone:414-566-8000
Mailing Address - Fax:414-291-2630
Practice Address - Street 1:2350 W VILLARD AVE
Practice Address - Street 2:STE 311
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209
Practice Address - Country:US
Practice Address - Phone:414-466-2424
Practice Address - Fax:414-466-2090
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2514033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41193900Medicaid
WI41193900Medicaid