Provider Demographics
NPI:1932421351
Name:MATHEWS, SKY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:SKY
Middle Name:LYNN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-6133
Mailing Address - Country:US
Mailing Address - Phone:608-931-8865
Mailing Address - Fax:
Practice Address - Street 1:2125 S PINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-6133
Practice Address - Country:US
Practice Address - Phone:608-931-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI312333-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse