Individual
MRS. JELLISA JUANA SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
3920 BRUMBAUGH BLVD, DAYTON, OH 45416-1545
(937) 559-8052
Mailing address
3920 BRUMBAUGH BLVD, DAYTON, OH 45416-1545
(937) 559-8052
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
400289301003
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
400289301003
OHIO DEPT OF HEALTH
OH
Enumeration date
10/31/2006
Last updated
07/08/2007
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