Provider Demographics
NPI:1114012853
Name:SKINNER, STEVEN KNOX (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:KNOX
Last Name:SKINNER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:KNOX
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:3583 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-951-0914
Mailing Address - Fax:
Practice Address - Street 1:MONTGOMERY REGIONAL HOSPITAL SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-953-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166227367500000X
VA0001192011367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered