Basic Information
| Provider Information | |||||||||
| NPI: | 1285249375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ST. JOHN | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 695 HORTON RD | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494451938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2312335722 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2201 S GETTY ST | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317399315 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2020 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 4704216288 | MI | Y | Nursing Service Providers | Registered Nurse | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 4704216288 | 01 | MI | LARA | OTHER |