Basic Information
| Provider Information | |||||||||
| NPI: | 1790780245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKALA | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148389000 | ||||||||
| FaxNumber: | 8148380462 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148389000 | ||||||||
| FaxNumber: | 8148380462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | OA000239L | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | MA002032L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 970023783 | 01 | PA | RAILROAD MEDICARE IND# | OTHER |