Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD00029754 | WA |
Y | 207VG0400X | Gynecologist | MD28930 | OR |
NPI | 1184602112 |
---|---|
Provider Name | Dr. Mary Elizabeth Skrypzak |
First Address | Portland, OR 97223-8692 |
Second Address | Portland, OR 97225-6772 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 23/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114842 | (05) | WA |
500633700 | (05) | OR |
F36822 | (02) | WA |
R175771 | MEDICARE PTAN (01) | OR |