Provider Demographics
NPI:1255520920
Name:ST.JOHN, MEREDITH (LICAC)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:
Last Name:ST.JOHN
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-6060
Mailing Address - Country:US
Mailing Address - Phone:508-650-1680
Mailing Address - Fax:508-650-6264
Practice Address - Street 1:207 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-6060
Practice Address - Country:US
Practice Address - Phone:508-650-1680
Practice Address - Fax:508-650-6264
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA546171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist