Provider Demographics
NPI:1295950319
Name:SKORICK, KRISTINE M
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:SKORICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8766 E HWY 69
Mailing Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT SPECIAL SERVICES OFFIC
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-772-2265
Mailing Address - Fax:
Practice Address - Street 1:8766 EAST HWY 69
Practice Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT 22 SPECIAL SERVICES OF
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4028
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN063950163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ580276Medicaid