Individual
MARIAH SKELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN CNP
Contact information
Practice address
5409 AVENUE O, FORT MADISON, IA 52627
(319) 376-1130
(319) 376-1131
Mailing address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-1130
(319) 376-1131
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
393933
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
021236
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
G151076
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
393833
LICENSE
OH
01
—
APRN.CNP.021236
LICENSE
OH
Enumeration date
06/01/2017
Last updated
05/23/2018
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