Provider Demographics
NPI:1154775328
Name:DZIEWA, SKYLER RHEANN
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:RHEANN
Last Name:DZIEWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SKYLER
Other - Middle Name:RHEANN
Other - Last Name:HERRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:324 S HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-2929
Mailing Address - Country:US
Mailing Address - Phone:580-475-0519
Mailing Address - Fax:
Practice Address - Street 1:324 S HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-2929
Practice Address - Country:US
Practice Address - Phone:580-475-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator