Provider Demographics
NPI:1619591575
Name:SKINNER, KATIE (RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 HUTCHINSON AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4751
Mailing Address - Country:US
Mailing Address - Phone:440-567-8069
Mailing Address - Fax:
Practice Address - Street 1:6027 DUDLEY CT
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-5469
Practice Address - Country:US
Practice Address - Phone:440-567-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1692801163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse