MEDICARE: MRS. ERNESTINE SKINNER

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	133V00000X	Registered Dietitian	L001190	NC

General Provider Information

NPI Number	:	1992922041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERNESTINE SKINNER

Provider Business Mailing Address
First Line	:	845 PARK AVE
Second Line	:	HENDERSON
City	:	HENDERSON
State	:	NC
Zip	:	27536-3101
Country	:	US
Telephone Number	:	252-430-1186
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 PARK AVE
Second Line	:	HENDERSON
City	:	HENDERSON
State	:	NC
Zip	:	27536-3101
Country	:	US
Telephone Number	:	252-430-1186
Fax Number	:

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

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

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