Healthcare Provider Details

I. General information

NPI: 1699034538
Provider Name (Legal Business Name): LESANDRA DEANNA SKINNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESANDRA DEANNA BENGE RN

II. Dates (important events)

Enumeration Date: 05/13/2012
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 INWOOD DR
WOBURN MA
01801-5130
US

IV. Provider business mailing address

255 GROTON RD
WESTFORD MA
01886-1324
US

V. Phone/Fax

Practice location:
  • Phone: 501-310-7610
  • Fax:
Mailing address:
  • Phone: 501-310-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN285484
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: