Basic Information
| Provider Information | |||||||||
| NPI: | 1982763900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKABO | ||||||||
| FirstName: | JO | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1721 ANALOG DR | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750811944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722766100 | ||||||||
| FaxNumber: | 9722761231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1721 ANALOG DR | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722766100 | ||||||||
| FaxNumber: | 9722761231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 460908 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 470862522 | 01 | TX | TAX ID | OTHER | 159462401 | 01 | TX | MEDICAID GROUP | OTHER | 140910403 | 05 | TX | MEDICAID |