Provider Demographics
NPI:1326030552
Name:SKINNER, SIDNEY HOWARD (RN)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:HOWARD
Last Name:SKINNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 GRUENE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3003
Mailing Address - Country:US
Mailing Address - Phone:830-625-0228
Mailing Address - Fax:
Practice Address - Street 1:1275 GRUENE RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3003
Practice Address - Country:US
Practice Address - Phone:830-625-0228
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX584521163WA2000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management