Healthcare Provider Details

I. General information

NPI: 1700852514
Provider Name (Legal Business Name): LINDA K SKAGGS OGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N RUTLEDGE ST BAYLIS BUILDING 2ND FLOOR
SPRINGFIELD IL
62702-6700
US

IV. Provider business mailing address

747 N RUTLEDGE ST BAYLIS BUILDING 2ND FLOOR
SPRINGFIELD IL
62702-6700
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-7932
  • Fax: 217-757-7920
Mailing address:
  • Phone: 217-757-7932
  • Fax: 217-757-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: