Provider Demographics
NPI:1760483820
Name:SKINNER, NADINE B (MD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:B
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 NASH ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-7803
Mailing Address - Country:US
Mailing Address - Phone:252-243-0053
Mailing Address - Fax:252-243-0054
Practice Address - Street 1:4845 NASH ST NW STE A
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-7803
Practice Address - Country:US
Practice Address - Phone:252-243-0053
Practice Address - Fax:252-243-0054
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5607382OtherFIRST HEALTH ID
NC13888OtherBC/BS ID
NC7686656OtherAETNA ID
NC1543OtherMEDCOST ID
NC6566251OtherCIGNA ID
NC313412OtherWELLPATH ID
NC5901071Medicaid
NC1543OtherMEDCOST ID
NC5901071Medicaid
NC2038823Medicare PIN