Provider Demographics
NPI:1316115314
Name:SKAGGS, MARLAINE (FNP)
Entity type:Individual
Prefix:MS
First Name:MARLAINE
Middle Name:
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S HARBOR BLVD
Mailing Address - Street 2:SUITE E 163
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6882
Mailing Address - Country:US
Mailing Address - Phone:714-733-3849
Mailing Address - Fax:
Practice Address - Street 1:777 S HARBOR BLVD
Practice Address - Street 2:SUITE E 163
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6882
Practice Address - Country:US
Practice Address - Phone:714-733-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ070ZMedicare UPIN
CABJ070WMedicare UPIN