Doctor Name: | MRS. MARY L. SKILES |
NPI Number: | 1063504629 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | R.D., LMNT, CDE |
License Number: | 503 |
Business Practice Address: | 3911 Avenue B Suite 1110 Scottsbluff, NE - 693614617 |
Business Phone Number: | 3082204305 |
Business Fax Number: | 3086302139 |
Mailing Address: | 3911 Avenue B, Suite 1110 SCOTTSBLUFF |
State: | NE |
Postal Code: | 693614617 |
Phone Number: | 3082204305 |
Fax Number: | 3086302139 |
NPI Enumeration Date: | 09/29/2006 |
NPI Last Update Date: | 11/06/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1004X |
License Number: | 503 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NE |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Pediatric |
Taxonomy Definition: |