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NPI 1194120188

IndividualActive

Jakarta Crafton, IDC

NPI 1194120188 · Independent Duty Corpsman · Groton, CT

Provider details

NPI number: 1194120188
Entity type: Individual
Primary specialty: Independent Duty CorpsmanOther Service Providers
Credential: IDC
Sex: Male
Sole proprietor: No

Practice location

15 Cypress Ln

Groton, CT 06340-3004

Phone: (904) 318-3271

More CT providers

Mailing address

15 Cypress Ln

Groton, CT 06340-3004

Registry dates

Enumerated: 2014-11-03
Last updated: 2014-11-03

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Jakarta Crafton, IDC — NPI 1194120188, Groton, CT | NPI Central