Healthcare Provider Details

I. General information

NPI: 1598966848
Provider Name (Legal Business Name): NAVAL HOSPITAL BREMERTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 BARB ST STE A
SILVERDALE WA
98315-2050
US

IV. Provider business mailing address

7300 MCCORMICK WOODS DR SW
PORT ORCHARD WA
98367-7476
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4363
  • Fax:
Mailing address:
  • Phone: 360-874-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name: WAYNE A GUY
Title or Position: IDC
Credential:
Phone: 360-315-4363