Healthcare Provider Details

I. General information

NPI: 1740628239
Provider Name (Legal Business Name): YVONNE ST. JOHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 BEAR DR
LAKE HAVASU CITY AZ
86406-4478
US

IV. Provider business mailing address

3916 BEAR DR
LAKE HAVASU CITY AZ
86406-4478
US

V. Phone/Fax

Practice location:
  • Phone: 928-230-6051
  • Fax:
Mailing address:
  • Phone: 928-230-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN134803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: