Provider Demographics
NPI:1932411279
Name:SKINNER-LUCAS, STEPHANIE EDWINA (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EDWINA
Last Name:SKINNER-LUCAS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:E
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MA, RD, LDN
Mailing Address - Street 1:PO BOX 830242
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1014 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1141
Practice Address - Country:US
Practice Address - Phone:855-699-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003175133V00000X
FL10945133V00000X
KY247514133V00000X
NCL003071133V00000X
WV701133V00000X
CT002360133V00000X
TN0000002420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered