Provider Demographics
NPI:1992221535
Name:SKONBERG, KAHLA (RN, DOULA)
Entity Type:Individual
Prefix:
First Name:KAHLA
Middle Name:
Last Name:SKONBERG
Suffix:
Gender:F
Credentials:RN, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-2100
Mailing Address - Country:US
Mailing Address - Phone:845-458-1252
Mailing Address - Fax:
Practice Address - Street 1:368 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-2100
Practice Address - Country:US
Practice Address - Phone:845-458-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY760486163W00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse