Healthcare Provider Details

I. General information

NPI: 1699504480
Provider Name (Legal Business Name): DAVID WESLEY SKILLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MISSION RANCH BLVD STE 10
CHICO CA
95926-5137
US

IV. Provider business mailing address

114 MISSION RANCH BLVD STE 10
CHICO CA
95926-5137
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-0500
  • Fax:
Mailing address:
  • Phone: 530-894-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: