Provider Demographics
NPI:1437924677
Name:SKOLNIK, KELLY RHEA BADGER (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RHEA BADGER
Last Name:SKOLNIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RHEA
Other - Last Name:HOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:11639 NW PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9807
Mailing Address - Country:US
Mailing Address - Phone:360-689-7374
Mailing Address - Fax:
Practice Address - Street 1:11639 NW PIONEER RD
Practice Address - Street 2:
Practice Address - City:SEABECK
Practice Address - State:WA
Practice Address - Zip Code:98380-9807
Practice Address - Country:US
Practice Address - Phone:360-689-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60765768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse