=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356204523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE SKIDMORE PSW
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 MARBLE AVE NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87106-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-5935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 VISTA DEL SOL
-----------------------------------------------------
City | TIJERAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87059-7917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-5935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------