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NPI Code Detail

MEDICARE: MARINA S LETOURNEAU IDC

MEDICARE: MARINA S LETOURNEAU IDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11710I1002XIndependent Duty Corpsman

General Provider Information

NPI Number : 1023355054
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINA S LETOURNEAU IDC
Provider Business Mailing Address
First Line : 1650 GATOR BLVD
Second Line : BLDG 3509 COMFIRSTNCD
City : VIRGINIA BEACH
State : VA
Zip : 23459-2435
Country : US
Telephone Number : 757-462-3587
Fax Number :
Provider Business Practice Location Address
First Line : 1650 GATOR BLVD
Second Line : BLDG 3509 COMFIRSTNCD
City : VIRGINIA BEACH
State : VA
Zip : 23459-2435
Country : US
Telephone Number : 757-462-3587
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2013
Last Update Date : 01/10/2013

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Directions to “ MARINA S LETOURNEAU IDC” Practice Location

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