Healthcare Provider Details

I. General information

NPI: 1669402772
Provider Name (Legal Business Name): REBECCA LYNN SKOVGAARD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CULVER RD
ROCHESTER NY
14609-7141
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7892
  • Fax: 585-341-6673
Mailing address:
  • Phone: 585-275-0638
  • Fax: 585-273-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: