Provider Demographics
NPI:1841553476
Name:SHERYL SKINNER FNP-BC PC
Entity type:Organization
Organization Name:SHERYL SKINNER FNP-BC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:480-299-7649
Mailing Address - Street 1:7119 E SHEA BLVD
Mailing Address - Street 2:STE 109 PMB 233
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6107
Mailing Address - Country:US
Mailing Address - Phone:480-299-7649
Mailing Address - Fax:866-761-1196
Practice Address - Street 1:10900 N SCOTTSDALE RD STE 201
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5228
Practice Address - Country:US
Practice Address - Phone:480-299-7649
Practice Address - Fax:866-761-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN083807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ496764Medicaid