MEDICARE: DONNA ELAINE SKIDGEL F.N.P.

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	363LW0102X	Women's Health Nurse Practitioner	381184	CA

General Provider Information

NPI Number	:	1841255916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA ELAINE SKIDGEL F.N.P.

Provider Business Mailing Address
First Line	:	10057 GARNET AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95212-2101
Country	:	US
Telephone Number	:	209-931-4702
Fax Number	:	916-689-8943

Provider Business Practice Location Address
First Line	:	7601 HOSPITAL DR
Second Line	:	SUITE 220
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5408
Country	:	US
Telephone Number	:	916-689-3433
Fax Number	:	916-689-8943

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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