MEDICARE: NATHANIEL SKINNER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1053258822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL SKINNER PHD

Provider Business Mailing Address
First Line	:	293 S MARYFIELD DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1537
Country	:	US
Telephone Number	:	518-231-8278
Fax Number	:

Provider Business Practice Location Address
First Line	:	729 S ARAPEEN DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1218
Country	:	US
Telephone Number	:	518-231-8278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2026
Last Update Date	:	04/30/2026

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