Provider Demographics
NPI:1902190804
Name:SKAATS, MARY K (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:SKAATS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8238 PRINCETON GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1675
Mailing Address - Country:US
Mailing Address - Phone:513-454-1307
Mailing Address - Fax:513-454-1309
Practice Address - Street 1:731 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3003
Practice Address - Country:US
Practice Address - Phone:937-573-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12376-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily