Healthcare Provider Details

I. General information

NPI: 1215253497
Provider Name (Legal Business Name): REBECCA E SKOLNIK PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LANCASTER ST
PORTLAND ME
04101-2406
US

IV. Provider business mailing address

165 LANCASTER ST
PORTLAND ME
04101-2406
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1030
  • Fax:
Mailing address:
  • Phone: 207-874-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP101018
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: