Provider Demographics
NPI:1649819871
Name:SKABELUND, HAYLEY (PA-C)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:SKABELUND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 W 129TH ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-3016
Mailing Address - Country:US
Mailing Address - Phone:708-377-2169
Mailing Address - Fax:708-293-1179
Practice Address - Street 1:4800 W 129TH ST
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-3016
Practice Address - Country:US
Practice Address - Phone:708-377-2169
Practice Address - Fax:708-293-1179
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006296RX363A00000X
IL085.008095363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant