Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OS13506 | FL |
N | 111NI0900X | Internist | OS13506 | FL |
Y | 207RG0100X | Gastroenterologist | 12618A | WY |
NPI | 1033524095 |
---|---|
Provider Name | Dr. Jamie Skrove |
First Address | Cheyenne, WY 82009-2667 |
Second Address | Cheyenne, WY 82009-2667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 21/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033524095 | (05) | WY |