Provider Demographics
NPI:1699413716
Name:SKIVER, MARY JO
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:SKIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 WHARF RD
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-4916
Mailing Address - Country:US
Mailing Address - Phone:804-445-6933
Mailing Address - Fax:
Practice Address - Street 1:248 WHARF RD
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-4916
Practice Address - Country:US
Practice Address - Phone:804-445-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA860500090133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered