Provider Demographics
NPI:1083807770
Name:SKINNER, LEANNE SHAW (CNM)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:SHAW
Last Name:SKINNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 RANCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5582
Mailing Address - Country:US
Mailing Address - Phone:281-996-7036
Mailing Address - Fax:
Practice Address - Street 1:1430 PASADENA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2414
Practice Address - Country:US
Practice Address - Phone:832-203-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740890367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K4218Medicare PIN