Provider Demographics
NPI:1982763900
Name:SKABO, JO ELAINE (CRNA)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELAINE
Last Name:SKABO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 ANALOG DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1944
Mailing Address - Country:US
Mailing Address - Phone:972-276-6100
Mailing Address - Fax:972-276-1231
Practice Address - Street 1:1721 ANALOG DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081
Practice Address - Country:US
Practice Address - Phone:972-276-6100
Practice Address - Fax:972-276-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX460908367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470862522OtherTAX ID
TX159462401OtherMEDICAID GROUP
TX140910403Medicaid
TX470862522OtherTAX ID