Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00717600 | NJ |
NPI | 1063941680 |
---|---|
Provider Name | Mrs. Megan Skinner |
First Address | Manasquan, NJ 08736-1147 |
Second Address | Manasquan, NJ 08736-1147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 07/06/2017 |