Provider Demographics
NPI:1164145256
Name:SKINNER, ANDREA JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:SKINNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-1414
Mailing Address - Country:US
Mailing Address - Phone:605-760-1440
Mailing Address - Fax:
Practice Address - Street 1:8300 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3705
Practice Address - Country:US
Practice Address - Phone:402-464-8302
Practice Address - Fax:402-464-8308
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA229491835P2201X
SD47351835P2201X
NE106311835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care