Provider Demographics
NPI:1871876144
Name:JOHN, IAN A (RN)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:A
Last Name:JOHN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1605
Mailing Address - Country:US
Mailing Address - Phone:585-429-7828
Mailing Address - Fax:
Practice Address - Street 1:9 DANIEL DR
Practice Address - Street 2:
Practice Address - City:GATES
Practice Address - State:NY
Practice Address - Zip Code:14624-1605
Practice Address - Country:US
Practice Address - Phone:585-429-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647979-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse