IndividualActive
Bryan Wallace, SOIDC
NPI 1336825926 · Independent Duty Corpsman · Camp Lejeune, NC
Provider details
- NPI number
- 1336825926
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- SOIDC
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Other Service Providers
Practice location
1st Marine Raider Battalion
Stone Bay
Camp Lejeune, NC 28542
Phone: (910) 440-2504
Approximate (ZIP-level) locationGet directions
Mailing address
Psc Box 20184
Camp Lejeune, NC 28542
Registry dates
- Enumerated
- 2023-06-27
- Last updated
- 2023-06-30
- Certified
- 2023-06-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.