Healthcare Provider Details

I. General information

NPI: 1538750898
Provider Name (Legal Business Name): SUSAN SKOCZYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S76W15425 WOODS RD
MUSKEGO WI
53150-8612
US

IV. Provider business mailing address

S76W15425 WOODS RD
MUSKEGO WI
53150-8612
US

V. Phone/Fax

Practice location:
  • Phone: 414-852-2058
  • Fax:
Mailing address:
  • Phone: 414-852-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number117315-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: