Provider Demographics
NPI:1164565347
Name:MEAD, JOHN MEACHAM (RN, BSN, LLMSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MEACHAM
Last Name:MEAD
Suffix:
Gender:M
Credentials:RN, BSN, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W BEECH BARK TRL
Mailing Address - Street 2:
Mailing Address - City:MAPLE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49664-9552
Mailing Address - Country:US
Mailing Address - Phone:231-228-4096
Mailing Address - Fax:
Practice Address - Street 1:1000 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3445
Practice Address - Country:US
Practice Address - Phone:231-947-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010875731041C0700X
MI4704145402163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine