Healthcare Provider Details

I. General information

NPI: 1043796717
Provider Name (Legal Business Name): RACHEL MARIE SKOVIRA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HARRISON ST STE 250
JOHNSON CITY NY
13790-2176
US

IV. Provider business mailing address

33 LEWIS RD 2ND FL
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-6580
  • Fax: 607-763-6782
Mailing address:
  • Phone: 607-729-8156
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07181424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: