Healthcare Provider Details

I. General information

NPI: 1447590948
Provider Name (Legal Business Name): JONATHAN PAUL SKRABAK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US HIGHWAY 6
VALPARAISO IN
46383-8947
US

IV. Provider business mailing address

PO BOX 10806
MERRILLVILLE IN
46411-0806
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-5743
  • Fax: 219-983-5994
Mailing address:
  • Phone: 219-983-5743
  • Fax: 219-983-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28172654A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: