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NPI 1760483820

NPI 1760483820 : NADINE B SKINNER MD : WILSON, NC

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General NPI Number Information
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    NPI Number           |    1760483820
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    Entity Type          |    Individual 
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    Provider Name        |    NADINE B SKINNER MD
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    08/10/2005
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    Last Update Date     |    10/12/2011
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Provider Practice Location Address
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    Address Line         |    4845 NASH ST NW STE A 
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    City                 |    WILSON
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    State                |    NC
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    Zip                  |    27896-7803
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    Country              |    US
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    Telephone            |    252-243-0053
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    Fax                  |    252-243-0054
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Provider Business Mailing Address
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    Address Line         |    4845 NASH ST NW STE A 
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    City                 |    WILSON
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    State                |    NC
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    Zip                  |    27896-7803
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    Country              |    US
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    Telephone            |    252-243-0053
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    Fax                  |    252-243-0054
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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        |    207Q00000X
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    Taxonomy Name        |    Family Medicine Physician
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    License Number       |    200400978
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    License Number State |    NC
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