Healthcare Provider Details

I. General information

NPI: 1750952834
Provider Name (Legal Business Name): ELIZABETH SKURNIK MS, RD, LD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 JOSEPH CIR
GOLDEN CO
80403-2348
US

IV. Provider business mailing address

777 JOSEPH CIR
GOLDEN CO
80403-2348
US

V. Phone/Fax

Practice location:
  • Phone: 720-273-0324
  • Fax:
Mailing address:
  • Phone: 720-273-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT87045
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number98985
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number913619
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: