Provider Demographics
NPI:1699759100
Name:SCOTT, DAWN LILLIAN (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LILLIAN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 WASHINGTON ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9314
Mailing Address - Country:US
Mailing Address - Phone:315-681-4367
Mailing Address - Fax:315-405-4585
Practice Address - Street 1:1511 WASHINGTON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9314
Practice Address - Country:US
Practice Address - Phone:315-681-4367
Practice Address - Fax:315-405-4585
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302341363LA2200X
NYF381241363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01865883Medicaid
NY01865883Medicaid
NYS61236Medicare UPIN