Healthcare Provider Details

I. General information

NPI: 1902984669
Provider Name (Legal Business Name): JASON BRAINARD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL PSC 827 BOX 45
NAPLES FPO AE
09617
IT

IV. Provider business mailing address

US NAVAL HOSPITAL PSC 827 BOX 45
NAPLES FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 81-811-6471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number26NR11362500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: