Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 202154 | MA |
NPI | 1073669255 |
---|---|
Provider Name | Mrs. Elaine Skawski |
First Address | Southampton, MA 01073-9651 |
Second Address | Holyoke, MA 01040-6603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P05341 | (02) | MA |