Provider Demographics
NPI:1598472243
Name:GREYEAGLE, SKYLAR ROBERT I (PASTOR)
Entity Type:Individual
Prefix:MRS
First Name:SKYLAR
Middle Name:ROBERT
Last Name:GREYEAGLE
Suffix:I
Gender:M
Credentials:PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W DIVIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1313
Mailing Address - Country:US
Mailing Address - Phone:701-224-9519
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN AVE APT 612
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4068
Practice Address - Country:US
Practice Address - Phone:701-224-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty