Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 3979 | MA |
NPI | 1366637738 |
---|---|
Provider Name | Dr. Eleanor Mary Skinner |
First Address | Amherst, MA 01002-3438 |
Second Address | Amherst, MA 01002-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 10/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WO3970 | BLUECROSSBLUESHIELD (01) | MA |