MEDICARE: AERIKA SKALICKY

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1598546822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AERIKA SKALICKY

Provider Business Mailing Address
First Line	:	PO BOX 95
Second Line	:
City	:	MANVEL
State	:	ND
Zip	:	58256-0095
Country	:	US
Telephone Number	:	701-721-0290
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 OXFORD STREET STOP 9025
Second Line	:	CNPD BUILDING ROOM 349
City	:	GRAND FORKS
State	:	ND
Zip	:	58202-5820
Country	:	US
Telephone Number	:	701-777-4521
Fax Number	:

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

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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Directions to “ AERIKA SKALICKY ” Practice Location

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