Provider Demographics
NPI:1962757476
Name:ST. JOHN, STACIA K (NP)
Entity type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:K
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:STACIA
Other - Middle Name:K
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:22 HINKLEY ST
Mailing Address - Street 2:
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252-1129
Mailing Address - Country:US
Mailing Address - Phone:207-713-3774
Mailing Address - Fax:
Practice Address - Street 1:1 TOGUS CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0001
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN57014163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse