Provider Demographics
NPI:1053699041
Name:ST JOHN, MARIANNE ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:MCGINTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8770 TRANSIT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1786
Mailing Address - Country:US
Mailing Address - Phone:716-245-4431
Mailing Address - Fax:716-245-4432
Practice Address - Street 1:8770 TRANSIT RD STE 3
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1786
Practice Address - Country:US
Practice Address - Phone:716-245-4431
Practice Address - Fax:716-245-4432
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03389044Medicaid
NYJ400146333Medicare PIN