Provider Demographics
NPI:1881395291
Name:SKINNER, KATHERINE MAURICE (NAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MAURICE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323-0059
Mailing Address - Country:US
Mailing Address - Phone:509-212-5919
Mailing Address - Fax:
Practice Address - Street 1:5505 W SKAGIT CT
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1374
Practice Address - Country:US
Practice Address - Phone:509-783-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide