Healthcare Provider Details

I. General information

NPI: 1316620784
Provider Name (Legal Business Name): JENNIE MAE SKURSKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 DEMOCRACY LN STE 203
FAIRFAX VA
22030-2545
US

IV. Provider business mailing address

10301 DEMOCRACY LN STE 203
FAIRFAX VA
22030-2545
US

V. Phone/Fax

Practice location:
  • Phone: 571-407-7816
  • Fax: 703-223-5042
Mailing address:
  • Phone: 571-407-7816
  • Fax: 703-223-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: