Provider Demographics
NPI:1558428458
Name:ST JOHN, ANGELA D (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1364
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-1364
Mailing Address - Country:US
Mailing Address - Phone:406-890-8305
Mailing Address - Fax:907-215-7963
Practice Address - Street 1:729 NUCLEUS AVE STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-4056
Practice Address - Country:US
Practice Address - Phone:406-890-8305
Practice Address - Fax:907-215-7963
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19254363LF0000X
MT105094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4310350Medicaid
MT4307277Medicaid
MT4310350Medicaid
MT374460OtherBCBS COUNTRY CLINIC
MT370111OtherBCBS HOSANNA HEALTHCARE
MT374460OtherBCBS COUNTRY CLINIC
MT4307277Medicaid