Provider Demographics
NPI:1861909913
Name:SCOTT, MARQUETTA SHANET'A
Entity type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:SHANET'A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1012
Mailing Address - Country:US
Mailing Address - Phone:216-394-3325
Mailing Address - Fax:
Practice Address - Street 1:1560 ANSEL RD APT 30
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4117
Practice Address - Country:US
Practice Address - Phone:216-394-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker