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NPI Code Detail

MEDICARE: MR. MARK PATRICK ST JOHN FNP

MEDICARE: MR. MARK PATRICK ST JOHN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF335622NY
2363L00000XNurse PractitionerF335622NY

General Provider Information

NPI Number : 1295999266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK PATRICK ST JOHN FNP
Provider Business Mailing Address
First Line : 7740 MEIGS RD
Second Line :
City : BALDWINSVILLE
State : NY
Zip : 13027-9757
Country : US
Telephone Number : 315-638-2521
Fax Number : 315-638-2552
Provider Business Practice Location Address
First Line : 7740 MEIGS RD
Second Line :
City : BALDWINSVILLE
State : NY
Zip : 13027-9757
Country : US
Telephone Number : 315-638-2521
Fax Number : 315-638-2552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2008
Last Update Date : 09/04/2020

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