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General NPI Number Information
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NPI Number | 1356418339
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Entity Type | Individual
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Provider Name | BRADLEY JAY HARTGERINK CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | NATIONAL NAVAL MEDICAL CTR 8901 WISCONSIN AVE.
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone | 301-295-4455
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Fax | 301-295-5063
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Provider Business Mailing Address
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Address Line | 3605 HUSTED DRIVE
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City | CHEVY CHASE
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State | MD
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Zip | 20815
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Country | US
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Telephone | 301-915-0380
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Fax | 301-295-5063
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704161718
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024164647
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License Number State | VA
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