Provider Demographics
NPI:1851105530
Name:NETHERTON, SCOTT RYAN (MSN, RN, CNOR, NE-BC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RYAN
Last Name:NETHERTON
Suffix:
Gender:M
Credentials:MSN, RN, CNOR, NE-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 PROVINCETOWN CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2756
Mailing Address - Country:US
Mailing Address - Phone:317-258-9159
Mailing Address - Fax:
Practice Address - Street 1:5255 E STOP 11 RD STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6341
Practice Address - Country:US
Practice Address - Phone:317-528-5900
Practice Address - Fax:317-528-5939
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28179182A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse