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
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.