Healthcare Provider Details

I. General information

NPI: 1235295601
Provider Name (Legal Business Name): DONNA CATHERINE SKOUBY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA MURPHY

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2166 MADISON AVE
GRANITE CITY IL
62040-4700
US

IV. Provider business mailing address

2166 MADISON AVE
GRANITE CITY IL
62040-4700
US

V. Phone/Fax

Practice location:
  • Phone: 618-219-3318
  • Fax: 618-452-3329
Mailing address:
  • Phone: 618-219-3318
  • Fax: 618-452-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041280057
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209001432
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: