Individual
COLTON SKENANDORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-8000
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4033-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100068094
—
WI
Enumeration date
04/12/2017
Last updated
04/10/2024
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