Healthcare Provider Details

I. General information

NPI: 1801245329
Provider Name (Legal Business Name): USN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 TRAVERSE CIRCLE
SUFFOLK VA
23435
US

IV. Provider business mailing address

3602 TRAVERSE CIR
SUFFOLK VA
23435-3216
US

V. Phone/Fax

Practice location:
  • Phone: 850-381-9724
  • Fax:
Mailing address:
  • Phone: 850-381-9724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number StateCT

VIII. Authorized Official

Name: BRETT NICHOLAS TURANO
Title or Position: SUBMARINE IDC
Credential:
Phone: 850-381-9724