Provider Demographics
NPI:1427297001
Name:NOVASCONE, SCOTT D (RN,RRT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:D
Last Name:NOVASCONE
Suffix:
Gender:M
Credentials:RN,RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BROTHERTON ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-1326
Mailing Address - Country:US
Mailing Address - Phone:906-224-1337
Mailing Address - Fax:
Practice Address - Street 1:407 BROTHERTON ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968-1326
Practice Address - Country:US
Practice Address - Phone:906-224-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263822163W00000X
WI2338-28174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2338-28OtherSTATE OF WISCONSIN
MI4704263822OtherSTATE OF MICHIGAN