Provider Demographics
NPI:1346676012
Name:SKOLASINSKI, MEGAN M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:M
Last Name:SKOLASINSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:VOIGTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2000
Mailing Address - Country:US
Mailing Address - Phone:618-498-8310
Mailing Address - Fax:618-498-3052
Practice Address - Street 1:414 S STATE ST
Practice Address - Street 2:
Practice Address - City:ROODHOUSE
Practice Address - State:IL
Practice Address - Zip Code:62082-1544
Practice Address - Country:US
Practice Address - Phone:217-589-4383
Practice Address - Fax:217-589-4409
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085004837OtherPROVIDER LICENSE
IL085004837OtherPROVIDER LICENSE
IL$$$$$$$$$001Medicaid