Provider Demographics
NPI:1780018861
Name:SKALIKS, VIVIANE B (FNP)
Entity Type:Individual
Prefix:
First Name:VIVIANE
Middle Name:B
Last Name:SKALIKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9991 MARSH LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1766
Mailing Address - Country:US
Mailing Address - Phone:214-358-0090
Mailing Address - Fax:214-526-6851
Practice Address - Street 1:9991 MARSH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1766
Practice Address - Country:US
Practice Address - Phone:214-358-0090
Practice Address - Fax:214-526-6851
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124264363LF0000X
TX802248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354762ZGPBMedicare PIN