Provider Demographics
NPI:1306093836
Name:SKOBLICKI, MARYANN (RN)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:SKOBLICKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CIRCLE DR W
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4294
Mailing Address - Country:US
Mailing Address - Phone:631-289-3626
Mailing Address - Fax:
Practice Address - Street 1:92 CIRCLE DR W
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4294
Practice Address - Country:US
Practice Address - Phone:631-289-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278790163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse