=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881009892
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA DUGAN SKROCKI APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2014
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4369 S SCENIC VIEW DR
-----------------------------------------------------
City | SUTTONS BAY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49682-9509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-493-2371
-----------------------------------------------------
Fax | 720-853-0034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4369 S SCENIC VIEW DR
-----------------------------------------------------
City | SUTTONS BAY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49682-9509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-493-2371
-----------------------------------------------------
Fax | 720-853-0034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | C-APN.0002431-C-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | C-RXN-0001254-C-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | NUR-APRN-LIC-100764
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 4704371939
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------