Provider Demographics
NPI:1568065134
Name:SKINNER, SHANDA RE' (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:RE'
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 ROSEBUD DR STE 7
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6294
Mailing Address - Country:US
Mailing Address - Phone:406-969-4812
Mailing Address - Fax:406-969-4814
Practice Address - Street 1:2040 ROSEBUD DR STE 8
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6294
Practice Address - Country:US
Practice Address - Phone:406-969-4812
Practice Address - Fax:406-969-4814
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse