Healthcare Provider Details

I. General information

NPI: 1275332892
Provider Name (Legal Business Name): BETHANY L SKOWRONSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ELM ST
GENOA IL
60135-1211
US

IV. Provider business mailing address

130 PRIMROSE LN
DAVIS JUNCTION IL
61020-9545
US

V. Phone/Fax

Practice location:
  • Phone: 630-740-4869
  • Fax:
Mailing address:
  • Phone: 630-740-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: