Individual
JOHANNES JACK BARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(801) 910-1089
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
113592-23
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA203060
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3151131
—
NH
Enumeration date
06/04/2018
Last updated
01/15/2026
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