Provider Demographics
NPI:1962643916
Name:SCOTT, ROSE (LVN)
Entity type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 AMERICANA WAY
Mailing Address - Street 2:#205
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91210-1523
Mailing Address - Country:US
Mailing Address - Phone:323-608-9895
Mailing Address - Fax:323-982-8516
Practice Address - Street 1:589 AMERICANA WAY
Practice Address - Street 2:#205
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91210-1523
Practice Address - Country:US
Practice Address - Phone:323-608-9895
Practice Address - Fax:323-982-8516
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 170020164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse