Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 201000064 | NC |
Y | 2080A0000X | Adolescent Medicine | 201000064 | NC |
NPI | 1073513875 |
---|---|
Provider Name | Dr. Anna Skaskiw |
First Address | Boston, MA 02298-6513 |
Second Address | Jacksonville, NC 28546-6328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 03/12/2020 |