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General NPI Number Information
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NPI Number | 1801277801
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Entity Type | Organization
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Legal Business Name | SKIN PC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 1935 E MILITARY AVE
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City | FREMONT
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State | NE
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Zip | 68025-5489
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Country | US
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Telephone | 402-727-7979
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Fax | 402-727-9306
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Provider Business Mailing Address
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Address Line | 1935 E MILITARY AVE
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City | FREMONT
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State | NE
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Zip | 68025-5489
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Country | US
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Telephone | 402-727-7979
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Fax | 402-727-9306
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Authorized Official
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Title or Position | OWNER
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Name | CHAD HILLYER
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Credential | PA-C
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Telephone | 402-727-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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