Provider Demographics
NPI:1407476823
Name:MICHALOVE, JEAN SKINNER (RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:SKINNER
Last Name:MICHALOVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:MICHALOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3490 BRIGHTON PL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6243
Mailing Address - Country:US
Mailing Address - Phone:770-354-0435
Mailing Address - Fax:
Practice Address - Street 1:3602 MARATHON CIR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6821
Practice Address - Country:US
Practice Address - Phone:770-222-0253
Practice Address - Fax:770-222-9415
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR122312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR122312OtherGA RN