Provider Demographics
NPI:1124637509
Name:SKINNER, DENISE DAWN RACHELLE (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:DAWN RACHELLE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 WOOLDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9698
Mailing Address - Country:US
Mailing Address - Phone:360-441-0908
Mailing Address - Fax:
Practice Address - Street 1:4101 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5514
Practice Address - Country:US
Practice Address - Phone:360-255-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00111943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty