Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN144854 | GA |
NPI | 1033122171 |
---|---|
Provider Name | Mrs. Susana Libhaber Skukalek |
First Address | Atlanta, GA 30306-3718 |
Second Address | Atlanta, GA 30322-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 25/09/2008 |