Provider Demographics
NPI:1659876399
Name:SKINNER, DIXIE JEAN (NP-C)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:JEAN
Last Name:SKINNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10637 W BARNSDALE CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1804
Mailing Address - Country:US
Mailing Address - Phone:208-859-2328
Mailing Address - Fax:
Practice Address - Street 1:10583 W. LAKE HAZEL RD.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8370
Practice Address - Country:US
Practice Address - Phone:208-302-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily