Provider Demographics
NPI:1497354815
Name:SKIDMORE, RHONDA SUE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUE
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16112 MOUNT SAVAGE RD NW
Mailing Address - Street 2:
Mailing Address - City:MOUNT SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:21545-1662
Mailing Address - Country:US
Mailing Address - Phone:304-788-7670
Mailing Address - Fax:
Practice Address - Street 1:16112 MOUNT SAVAGE RD NW
Practice Address - Street 2:
Practice Address - City:MOUNT SAVAGE
Practice Address - State:MD
Practice Address - Zip Code:21545-1662
Practice Address - Country:US
Practice Address - Phone:304-788-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator