Provider Demographics
NPI:1659633196
Name:SKORDAL, AMY JO (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:SKORDAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 SW 136TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:206-257-6600
Mailing Address - Fax:206-257-6830
Practice Address - Street 1:1210 SW 136TH STREET
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-257-6600
Practice Address - Fax:206-257-6820
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60503166363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2041895Medicaid
WA2041895Medicaid