Lonnie Jay Reardon, Submarine IDC
Military Health Care Provider, Independent Duty Corpsman in Groton, CT. Individual provider (NPI-1).
NPI number1982244737
StatusActive
Last updated in NPPESJan 9, 2020
Details
- NPI
- 1982244737
- Entity type
- Individual (NPI-1)
- Name
- Lonnie Jay Reardon
- Credential
- Submarine IDC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 9, 2020
- Certification date
- Jan 9, 2020
- Last updated
- Jan 9, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | – | – | Yes |
Practice location
55 South Rd Apt 12cGroton, CT 06340-4660
Phone 224-436-0181
Mailing address
55 South Rd Apt 12cGroton, CT 06340-4660
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