Provider Demographics
NPI:1962710046
Name:SKINNER, CHRISTINA MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:MT
Mailing Address - Zip Code:59436-0206
Mailing Address - Country:US
Mailing Address - Phone:406-781-8294
Mailing Address - Fax:
Practice Address - Street 1:867 1ST RD NE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:MT
Practice Address - Zip Code:59436-9141
Practice Address - Country:US
Practice Address - Phone:406-781-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT577133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1010762OtherDIETETIC REGISTRATION ID NUMBER