=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134969280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER C SKOW PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2024
-----------------------------------------------------
Last Update Date | 05/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 US HIGHWAY 220
-----------------------------------------------------
City | MUNCY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17756-6561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-230-4565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2144 TEABERRY LN
-----------------------------------------------------
City | LOCK HAVEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17745-9778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-502-1527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------