Healthcare Provider Details

I. General information

NPI: 1114391224
Provider Name (Legal Business Name): KATHRYN SKIBINSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20251 JOHN J WILLIAMS HWY
LEWES DE
19958-4314
US

IV. Provider business mailing address

20251 JOHN J WILLIAMS HWY
LEWES DE
19958-4314
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6860
  • Fax: 302-644-6872
Mailing address:
  • Phone: 302-644-6860
  • Fax: 302-644-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001177
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: