Healthcare Provider Details

I. General information

NPI: 1376151027
Provider Name (Legal Business Name): DANA SKONSENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA ROACH MD

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13060 ISLE DR
BAXTER MN
56425-8331
US

IV. Provider business mailing address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 218-454-5935
  • Fax:
Mailing address:
  • Phone: 701-364-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8836
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number76979
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: