Healthcare Provider Details

I. General information

NPI: 1083807770
Provider Name (Legal Business Name): LEANNE SHAW SKINNER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2007
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PASADENA BLVD SUITE D
PASADENA TX
77502-2414
US

IV. Provider business mailing address

212 RANCHWOOD LN
FRIENDSWOOD TX
77546-5582
US

V. Phone/Fax

Practice location:
  • Phone: 832-203-5523
  • Fax:
Mailing address:
  • Phone: 281-996-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number740890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: