Basic Information
| Provider Information | |||||||||
| NPI: | 1649677485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKINNER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 SHUMAN BLVD | ||||||||
| Address2: | STE 401 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605638458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303035380 | ||||||||
| FaxNumber: | 9783136824 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 EL CERRITO PLZ | ||||||||
| Address2: | |||||||||
| City: | EL CERRITO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945304002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105263824 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2014 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA 60483497 | WA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | HA8373 | CA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 8373 | CA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.