MEDICARE: EMMA CATHERINE SKILLMAN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F02230555	MI

General Provider Information

NPI Number	:	1306535000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA CATHERINE SKILLMAN FNP-C

Provider Business Mailing Address
First Line	:	2345 AUSTIN DR
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-1914
Country	:	US
Telephone Number	:	248-504-1814
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 AUSTIN DR
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-1914
Country	:	US
Telephone Number	:	248-504-1814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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