Individual
TAMMY L SKIDMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
Mailing address
PO BOX 4107, POCATELLO, ID 83205-4107
(208) 232-7760
(208) 232-1950
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N27623
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-582
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145477
BCBS KS GROUP 110017
KS
05
—
200429720A
—
KS
05
—
806817800
—
ID
Enumeration date
05/12/2006
Last updated
11/01/2011
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