Healthcare Provider Details

I. General information

NPI: 1619204377
Provider Name (Legal Business Name): JOSIE MARIE SKAVDAHL ND, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LAFAYETTE ST SUITE 3A
YARMOUTH ME
04096-6125
US

IV. Provider business mailing address

106 LAFAYETTE ST SUITE 3A
YARMOUTH ME
04096-6125
US

V. Phone/Fax

Practice location:
  • Phone: 207-846-4900
  • Fax: 207-846-4901
Mailing address:
  • Phone: 207-846-4900
  • Fax: 207-846-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP337
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number09090021
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: