Healthcare Provider Details

I. General information

NPI: 1053258822
Provider Name (Legal Business Name): NATHANIEL SKINNER PHD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 S ARAPEEN DR
SALT LAKE CITY UT
84108-1218
US

IV. Provider business mailing address

293 S MARYFIELD DR
SALT LAKE CITY UT
84108-1537
US

V. Phone/Fax

Practice location:
  • Phone: 518-231-8278
  • Fax:
Mailing address:
  • Phone: 518-231-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: