Provider Demographics
NPI:1295050813
Name:MIDLA, JOHN (RN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MIDLA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 E MAIN STREET RD
Mailing Address - Street 2:SUITE2
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3496
Mailing Address - Country:US
Mailing Address - Phone:585-344-1421
Mailing Address - Fax:585-345-3080
Practice Address - Street 1:5130 E MAIN STREET RD
Practice Address - Street 2:SUITE2
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3496
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:585-345-3080
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY435767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse