Provider Demographics
NPI:1801550330
Name:SKARO, NICOLE ANN (BA, PEND MPH, CPPS)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:SKARO
Suffix:
Gender:F
Credentials:BA, PEND MPH, CPPS
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:SKARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, PEND MPH, CPPS
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-0293
Mailing Address - Country:US
Mailing Address - Phone:952-258-9861
Mailing Address - Fax:
Practice Address - Street 1:1683 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-4549
Practice Address - Country:US
Practice Address - Phone:952-258-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker