Provider Demographics
NPI:1235295601
Name:SKOUBY, DONNA CATHERINE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:CATHERINE
Last Name:SKOUBY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2166 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4700
Mailing Address - Country:US
Mailing Address - Phone:618-219-3318
Mailing Address - Fax:618-452-3329
Practice Address - Street 1:2166 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4700
Practice Address - Country:US
Practice Address - Phone:618-219-3318
Practice Address - Fax:618-452-3329
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041280057163W00000X
IL209001432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse