Provider Demographics
NPI:1437443033
Name:ST JOHN, SENA RAE (DO)
Entity Type:Individual
Prefix:
First Name:SENA
Middle Name:RAE
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SENA
Other - Middle Name:RAE
Other - Last Name:ST JOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:550 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-2202
Mailing Address - Country:US
Mailing Address - Phone:616-523-1600
Mailing Address - Fax:
Practice Address - Street 1:550 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-2202
Practice Address - Country:US
Practice Address - Phone:616-523-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine