Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 46234 | KY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 46234 | KY |
NPI | 1295046688 |
---|---|
Provider Name | Dr. Jennifer J Skorupa |
First Address | Lexington, KY 40504-3229 |
Second Address | Lexington, KY 40504-3229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 08/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100295430 | (05) | KY |