Healthcare Provider Details

I. General information

NPI: 1043567431
Provider Name (Legal Business Name): ANA ALYSS SKORYK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4960
US

IV. Provider business mailing address

75 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4960
US

V. Phone/Fax

Practice location:
  • Phone: 617-495-5711
  • Fax:
Mailing address:
  • Phone: 401-742-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269671
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: