Individual
MR. JONATHAN BROCKMEYER MARDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, CRNA
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-4000
Mailing address
1290 W GOVERNMENT ST APT T158, BRANDON, MS 39042-2445
(601) 938-0322
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
152511
MS
Other
Enumeration date
12/31/2024
Last updated
12/31/2024
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