Provider Demographics
NPI:1578193462
Name:VANDER VORST, SKYLER (DOULA)
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:VANDER VORST
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:SKYLER
Other - Middle Name:LAINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOULA
Mailing Address - Street 1:1530 ARMSTRONG AVE N
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-1229
Mailing Address - Country:US
Mailing Address - Phone:320-510-4128
Mailing Address - Fax:
Practice Address - Street 1:1530 ARMSTRONG AVE N
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1229
Practice Address - Country:US
Practice Address - Phone:320-510-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula