Provider Demographics
NPI:1285255646
Name:SKUFCA, LAURA (CNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SKUFCA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 LEE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1604
Mailing Address - Country:US
Mailing Address - Phone:216-224-4629
Mailing Address - Fax:
Practice Address - Street 1:21100 SOUTHGATE PARK BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3004
Practice Address - Country:US
Practice Address - Phone:216-663-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH026466363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health