Provider Demographics
NPI:1902984669
Name:BRAINARD, JASON (RN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BRAINARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US NAVAL HOSPITAL
Mailing Address - Street 2:PSC 827 BOX 45
Mailing Address - City:NAPLES
Mailing Address - State:FPO AE
Mailing Address - Zip Code:09617
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL
Practice Address - Street 2:PSC 827 BOX 45
Practice Address - City:NAPLES
Practice Address - State:FPO AE
Practice Address - Zip Code:09617
Practice Address - Country:IT
Practice Address - Phone:081-811-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11362500163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical