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General NPI Number Information
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NPI Number | 1629506829
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Entity Type | Individual
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Provider Name | MARIAH SKELLEY APRN CNP
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Gender | Female
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 5409 AVENUE O
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City | FORT MADISON
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State | IA
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Zip | 52627
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Country | US
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Telephone | 319-376-1130
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Fax | 319-376-1131
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Provider Business Mailing Address
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Address Line | 5409 AVENUE O
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City | FORT MADISON
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State | IA
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Zip | 52627-9601
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Country | US
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Telephone | 319-376-1130
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Fax | 319-376-1131
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 393933
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 021236
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | G151076
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License Number State | IA
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