Healthcare Provider Details

I. General information

NPI: 1194031468
Provider Name (Legal Business Name): DEBORAH SKOP LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W WASHINGTON ST SUITE B
WAUSAU WI
54403-5475
US

IV. Provider business mailing address

209 W WASHINGTON ST SUITE B
WAUSAU WI
54403-5475
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-3637
  • Fax: 715-845-1977
Mailing address:
  • Phone: 715-845-3637
  • Fax: 715-845-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number310776-031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: