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Individual

JERRY LENDO BRANTLEY JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
2080 W ARLINGTON BLVD, STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
Mailing address
2080 W ARLINGTON BLVD, STE B, GREENVILLE, NC 27834-3770
(252) 752-2140

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
186544
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
84747
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1407173867
TRICARE
NC
05
8053788
NC
01
P00835163
RAILROAD MEDICARE
NC
Enumeration date
04/26/2010
Last updated
03/30/2021
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