Provider Demographics
NPI:1588996896
Name:SCANLAN-RATHBUN, NANCY M (NPP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:SCANLAN-RATHBUN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3315
Mailing Address - Country:US
Mailing Address - Phone:518-563-8000
Mailing Address - Fax:518-563-9001
Practice Address - Street 1:63 BROAD ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3315
Practice Address - Country:US
Practice Address - Phone:518-563-8000
Practice Address - Fax:518-563-9001
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401207363LP0808X
NY0184588-01364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult