Healthcare Provider Details

I. General information

NPI: 1659633196
Provider Name (Legal Business Name): AMY JO SKORDAL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH STREET
BURIEN WA
98166
US

IV. Provider business mailing address

1210 SW 136TH ST
BURIEN WA
98166
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6600
  • Fax: 206-257-6820
Mailing address:
  • Phone: 206-257-6600
  • Fax: 206-257-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60503166
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: