Provider Demographics
NPI:1275048738
Name:ST JOHN NP IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:ST JOHN NP IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ST JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-491-3221
Mailing Address - Street 1:8770 TRANSIT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1786
Mailing Address - Country:US
Mailing Address - Phone:716-245-4431
Mailing Address - Fax:716-245-4432
Practice Address - Street 1:8770 TRANSIT RD STE 3
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1786
Practice Address - Country:US
Practice Address - Phone:716-245-4431
Practice Address - Fax:716-245-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty