Provider Demographics
NPI:1518360072
Name:U.S. NAVY
Entity type:Organization
Organization Name:U.S. NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEARSE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:775-426-3125
Mailing Address - Street 1:4755 PASTURE RD
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89496-3115
Mailing Address - Country:US
Mailing Address - Phone:775-426-3126
Mailing Address - Fax:
Practice Address - Street 1:4755 PASTURE RD
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89496-3115
Practice Address - Country:US
Practice Address - Phone:775-426-3126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60510295261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)