Provider Demographics
NPI:1821718289
Name:SKY, JANE RIVER (RN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:RIVER
Last Name:SKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 RED PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9477
Mailing Address - Country:US
Mailing Address - Phone:616-648-4034
Mailing Address - Fax:
Practice Address - Street 1:976 RED PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9477
Practice Address - Country:US
Practice Address - Phone:616-648-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse