Healthcare Provider Details

I. General information

NPI: 1871576256
Provider Name (Legal Business Name): KRISTIN ANN SKORACZEWSKI PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 N 12TH ST SUITE 1800
MILWAUKEE WI
53233-1306
US

IV. Provider business mailing address

960 N 12TH ST SUITE 1800
MILWAUKEE WI
53233-1306
US

V. Phone/Fax

Practice location:
  • Phone: 414-278-9000
  • Fax: 414-278-9005
Mailing address:
  • Phone: 414-278-9000
  • Fax: 414-278-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1197-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: