Provider Demographics
NPI:1770598138
Name:SKOG, CHRYSTIN MARY (PA-C)
Entity type:Individual
Prefix:
First Name:CHRYSTIN
Middle Name:MARY
Last Name:SKOG
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:651-254-8300
Mailing Address - Fax:651-254-8379
Practice Address - Street 1:435 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-8300
Practice Address - Fax:651-254-8379
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN11083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant