Healthcare Provider Details

I. General information

NPI: 1780107714
Provider Name (Legal Business Name): BONNIE KATHERINE SKARZINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 205
CHARLESTON WV
25304-1228
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 205
CHARLESTON WV
25304-1228
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-7305
  • Fax: 304-720-7310
Mailing address:
  • Phone: 304-720-7305
  • Fax: 304-720-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN85513-NP-C
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: