Individual provider · NPI-1

Jesse James Anthony, SOIDC

Military Health Care Provider, Independent Duty Corpsman · Camp Lejeune, NC

NPI number1205501384
StatusActive
Last updated in NPPESAug 11, 2021

Details

NPI
1205501384
Entity type
Individual (NPI-1)
Name
Jesse James Anthony
Credential
SOIDC
Sex
Male
Sole proprietor
No
Enumeration date
Aug 11, 2021
Certification date
Jul 16, 2021
Last updated
Aug 11, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1710I1002X Military Health Care Provider, Independent Duty Corpsman––Yes

Practice location

1st Mar Rdr Bn Mrr Marforsoc
Bldg 132
Camp Lejeune, NC 28542

Phone 910-440-2497

Mailing address

1st Mar Rdr Bn Mrr Marforsoc
Pcs Box 20184
Camp Lejeune, NC 28542

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Military Health Care Provider, Independent Duty Corpsman providers in Camp Lejeune, NC