Individual
ANDREA NICOLE SKIDMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1060 STEWART ST, NEWARK, OH 43055-6030
(740) 405-1184
Mailing address
1060 STEWART ST, NEWARK, OH 43055-6030
(740) 405-1184
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.154288.MEDS-IV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09161988
MEDICARE
OH
05
—
09161988
—
OH
Enumeration date
05/18/2020
Last updated
05/11/2026
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