Provider Demographics
NPI:1003635145
Name:CREESE, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CREESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2532
Mailing Address - Country:US
Mailing Address - Phone:412-482-4521
Mailing Address - Fax:
Practice Address - Street 1:640 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4119
Practice Address - Country:US
Practice Address - Phone:724-374-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030789363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health