MEDICARE: DONNA T SKINNER FNP

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	363LF0000X	Family Nurse Practitioner	277.002590	IL

General Provider Information

NPI Number	:	1851874929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA T SKINNER FNP

Provider Business Mailing Address
First Line	:	1107 BUELL AVE
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-6851
Country	:	US
Telephone Number	:	708-925-2613
Fax Number	:

Provider Business Practice Location Address
First Line	:	2613 W 98TH ST
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-3237
Country	:	US
Telephone Number	:	708-925-2613
Fax Number	:

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

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	10/30/2024

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