Provider Demographics
NPI:1942695887
Name:ST JOHN, CLAIRE (RD)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:RD
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 296
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-0296
Mailing Address - Country:US
Mailing Address - Phone:530-312-0603
Mailing Address - Fax:
Practice Address - Street 1:32328 NORDIC DRIVE
Practice Address - Street 2:
Practice Address - City:RUNNING SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92382-0296
Practice Address - Country:US
Practice Address - Phone:530-312-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86017593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered