Provider Demographics
NPI:1508917659
Name:SKYBERG, ANGELA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:SKYBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT
Mailing Address - Street 1:BRIDGES MEDICAL CENTER
Mailing Address - Street 2:201 9TH STREET W.
Mailing Address - City:ADA
Mailing Address - State:MN
Mailing Address - Zip Code:56510
Mailing Address - Country:US
Mailing Address - Phone:218-784-5000
Mailing Address - Fax:218-784-3753
Practice Address - Street 1:BRIDGES MEDICAL CENTER
Practice Address - Street 2:201 9TH STREET W.
Practice Address - City:ADA
Practice Address - State:MN
Practice Address - Zip Code:56510
Practice Address - Country:US
Practice Address - Phone:218-784-5000
Practice Address - Fax:218-784-3753
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1055636OtherNCCPA - NAT.CERT.COMM.PA
MN9758OtherSTATE OF MN PA LICENSE
MN144098500Medicaid
P74665Medicare UPIN