Provider Demographics
NPI:1700852514
Name:SKAGGS, LINDA K (OGNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 N RUTLEDGE ST
Mailing Address - Street 2:BAYLIS BUILDING 2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6700
Mailing Address - Country:US
Mailing Address - Phone:217-757-7932
Mailing Address - Fax:217-757-7920
Practice Address - Street 1:747 N RUTLEDGE ST
Practice Address - Street 2:BAYLIS BUILDING 2ND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-757-7932
Practice Address - Fax:217-757-7920
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL87171Medicare ID - Type Unspecified
S06330Medicare UPIN