Ian A John, RN
Individual provider Active NPI Registered Nurse · Gates, NY
NPI 1871876144 · NPPES record last updated Sep 23, 2011
Key facts
- NPI
- 1871876144
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 647979-1 (NY)
- Practice address
- 9 Daniel Dr
Gates, NY 14624-1605 - Phone
- (585) 429-7828
- NPI assigned
- Sep 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 647979-1 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 647979-1 | NY | Yes |
Addresses
Primary practice location
9 Daniel Dr
Gates, NY 14624-1605
Mailing address
9 Daniel Dr
Gates, NY 14624-1605
Phone (585) 429-7828
Other providers in Gates, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.