Healthcare Provider Details

I. General information

NPI: 1437150638
Provider Name (Legal Business Name): ALICIA J. SKINNER RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA FIORI RPA-C

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT ST SUITE 106
BALLSTON SPA NY
12020-1367
US

IV. Provider business mailing address

20 PROSPECT ST SUITE 106
BALLSTON SPA NY
12020-1367
US

V. Phone/Fax

Practice location:
  • Phone: 518-885-3755
  • Fax: 518-885-4613
Mailing address:
  • Phone: 518-885-3755
  • Fax: 518-885-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: