Provider Demographics
NPI:1073890505
Name:VENEZIA SKAGGS, DARLENE G (MSN,NP-C)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:G
Last Name:VENEZIA SKAGGS
Suffix:
Gender:
Credentials:MSN,NP-C
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:G
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3267
Mailing Address - Country:US
Mailing Address - Phone:814-368-1000
Mailing Address - Fax:814-368-1008
Practice Address - Street 1:1001 E. MAIN SREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1036
Practice Address - Country:US
Practice Address - Phone:814-368-1000
Practice Address - Fax:814-368-1008
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011771363L00000X
NY338303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP011771OtherNP LICENSE
PA102678643Medicaid