Provider Demographics
NPI:1427799600
Name:SKINNER, MARY TALBOT
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:TALBOT
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 20TH AVE S
Mailing Address - Street 2:#2
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2322 20TH AVE S
Practice Address - Street 2:#2
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223
Practice Address - Country:US
Practice Address - Phone:912-401-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-182421163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical