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General NPI Number Information
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NPI Number | 1588344121
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Entity Type | Individual
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Provider Name | SHEAMUS MICHAEL NAKADA MILITARY PROVIDER
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Gender | Male
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1ST MARINE RAIDER BATTALION AID STATION
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City | SNEADS FERRY
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State | NC
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Zip | 28460
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Country | US
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Telephone | 910-440-2499
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Fax |
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Provider Business Mailing Address
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Address Line | 408 SAVANNAH DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-8673
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Country | US
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Telephone | 630-329-5556
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Fax |
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number | 05225409SN
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License Number State | NC
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