Provider Demographics
NPI:1356435929
Name:SKALLA, KAREN ALICIA (APRN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ALICIA
Last Name:SKALLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC HEMATOLOGY ONCOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-8626
Mailing Address - Fax:603-650-7791
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC HEMATOLOGY ONCOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041741-23363LA2200X
VT1010023129363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP2784Medicaid
NH30341009Medicaid
P15185Medicare UPIN
NH30341009Medicaid
NHNP278403Medicare PIN