1760483820 NPI number — DR. NADINE B SKINNER MD

Table of content: DR. NADINE B SKINNER MD (NPI 1760483820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760483820 NPI number — DR. NADINE B SKINNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKINNER
Provider First Name:
NADINE
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760483820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4845 NASH ST NW STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27896-7803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-243-0053
Provider Business Mailing Address Fax Number:
252-243-0054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4845 NASH ST NW STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27896-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-243-0053
Provider Business Practice Location Address Fax Number:
252-243-0054
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  200400978 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5607382 . This is a "FIRST HEALTH ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13888 . This is a "BC/BS ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7686656 . This is a "AETNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1543 . This is a "MEDCOST ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6566251 . This is a "CIGNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 313412 . This is a "WELLPATH ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5901071 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com