Provider Demographics
NPI:1649090457
Name:SKILLEN, NELLIE (FNP)
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:SKILLEN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 LONG BEACH BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2011
Mailing Address - Country:US
Mailing Address - Phone:323-588-3300
Mailing Address - Fax:323-588-0855
Practice Address - Street 1:8204 LONG BEACH BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2011
Practice Address - Country:US
Practice Address - Phone:323-588-3300
Practice Address - Fax:323-588-0855
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily