Provider Demographics
NPI:1699034538
Name:SKINNER, LESANDRA DEANNA (RN)
Entity Type:Individual
Prefix:
First Name:LESANDRA
Middle Name:DEANNA
Last Name:SKINNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LESANDRA
Other - Middle Name:DEANNA
Other - Last Name:BENGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:255 GROTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1324
Mailing Address - Country:US
Mailing Address - Phone:501-310-7610
Mailing Address - Fax:
Practice Address - Street 1:2132 INWOOD DR
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-5130
Practice Address - Country:US
Practice Address - Phone:501-310-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN285484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered