Individual
JO ELAINE SKABO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1721 ANALOG DR, RICHARDSON, TX 75081
(972) 276-6100
(972) 276-1231
Mailing address
1721 ANALOG DR, RICHARDSON, TX 75081-1944
(972) 276-6100
(972) 276-1231
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
460908
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140910403
—
TX
01
—
159462401
MEDICAID GROUP
TX
01
—
470862522
TAX ID
TX
Enumeration date
12/06/2006
Last updated
06/14/2018
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