Provider Demographics
NPI:1659916260
Name:ST. JOHN, VIRGINIA KAY
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:KAY
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 DEER FIELD COURT
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135
Mailing Address - Country:US
Mailing Address - Phone:217-433-7562
Mailing Address - Fax:
Practice Address - Street 1:961 DEER FIELD COURT
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:217-433-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider