MEDICARE: MRS. CHRISTINA MARIE SKINNER RD

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	133N00000X	Nutritionist	577	MT
2	133V00000X	Registered Dietitian	577	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1010762	OTHER	MT	DIETETIC REGISTRATION ID NUMBER

General Provider Information

NPI Number	:	1962710046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA MARIE SKINNER RD

Provider Business Mailing Address
First Line	:	PO BOX 206
Second Line	:
City	:	FAIRFIELD
State	:	MT
Zip	:	59436-0206
Country	:	US
Telephone Number	:	406-781-8294
Fax Number	:

Provider Business Practice Location Address
First Line	:	867 1ST RD NE
Second Line	:
City	:	FAIRFIELD
State	:	MT
Zip	:	59436-9141
Country	:	US
Telephone Number	:	406-781-8294
Fax Number	:

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/13/2018

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