Provider Demographics
NPI:1801968235
Name:ST. JOHN, LAURA MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N MITCHNER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3820
Mailing Address - Country:US
Mailing Address - Phone:317-357-4733
Mailing Address - Fax:
Practice Address - Street 1:1700 W SMITH VALLEY RD
Practice Address - Street 2:STE. C-1
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1599
Practice Address - Country:US
Practice Address - Phone:317-882-3370
Practice Address - Fax:317-859-5020
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144528A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse