MEDICARE: MRS. ABBY JO SKENDER MSN, APRN, PMHNP-BC

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	163W00000X	Registered Nurse	4704317555	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704317555NSA22036	MI

General Provider Information

NPI Number	:	1255977906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABBY JO SKENDER MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	42815 GARFIELD RD STE 210
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-846-4835
Fax Number	:

Provider Business Practice Location Address
First Line	:	42815 GARFIELD RD STE 210
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-846-4835
Fax Number	:

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

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	06/09/2022

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