Provider Demographics
NPI:1992511166
Name:SCOTT, DWAYNE
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27378 PARKVIEW BLVD APT 4314
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3501
Mailing Address - Country:US
Mailing Address - Phone:586-339-2178
Mailing Address - Fax:
Practice Address - Street 1:133 E GRAND BLVD APT 208
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3777
Practice Address - Country:US
Practice Address - Phone:586-339-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker