Provider Demographics
NPI:1942471099
Name:SKINNER, VICKI SUE (LAC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:SUE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3137
Mailing Address - Country:US
Mailing Address - Phone:718-886-6898
Mailing Address - Fax:718-886-1949
Practice Address - Street 1:14105 33RD AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3137
Practice Address - Country:US
Practice Address - Phone:718-886-6898
Practice Address - Fax:718-886-1949
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003461171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist