Provider Demographics
NPI:1699060707
Name:SKVARICH, JANE MARY (RN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARY
Last Name:SKVARICH
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 1:2701 RANGEWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1577
Mailing Address - Country:US
Mailing Address - Phone:770-337-1801
Mailing Address - Fax:
Practice Address - Street 1:2701 RANGEWOOD DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1577
Practice Address - Country:US
Practice Address - Phone:770-337-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN067233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse