Provider Demographics
NPI:1821789223
Name:SKEEHAN, ALLI ELIZABETH ANNE
Entity Type:Individual
Prefix:
First Name:ALLI
Middle Name:ELIZABETH ANNE
Last Name:SKEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:SKEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4605 CALLE CHICO
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-7157
Mailing Address - Country:US
Mailing Address - Phone:707-342-0831
Mailing Address - Fax:
Practice Address - Street 1:5750 E HIGHWAY 90 STE 375
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-9114
Practice Address - Country:US
Practice Address - Phone:520-263-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN192953163W00000X
AZRNP293053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse