Healthcare Provider Details

I. General information

NPI: 1275349433
Provider Name (Legal Business Name): JEANNE SKONDIN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 HOWE AVE
SACRAMENTO CA
95825-3912
US

IV. Provider business mailing address

855 HOWE AVE
SACRAMENTO CA
95825-3912
US

V. Phone/Fax

Practice location:
  • Phone: 916-223-8380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number206093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: