Provider Demographics
NPI:1811538275
Name:BRUCKER-SKELTON, ELIZABETH (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:BRUCKER-SKELTON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25625 SELMA RD
Mailing Address - Street 2:
Mailing Address - City:JETERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25625 SELMA RD
Practice Address - Street 2:
Practice Address - City:JETERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23083
Practice Address - Country:US
Practice Address - Phone:804-561-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider