Provider Demographics
NPI:1164572442
Name:ST.JOHN, ANITA MARY (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARY
Last Name:ST.JOHN
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 1:41 BAYDEN PATH
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1796
Mailing Address - Country:US
Mailing Address - Phone:508-224-7607
Mailing Address - Fax:
Practice Address - Street 1:275 CAMBRIDGE ST
Practice Address - Street 2:POB
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3108
Practice Address - Country:US
Practice Address - Phone:617-643-2223
Practice Address - Fax:617-724-2803
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse