Individual
MR. JASON ANDREW LA BENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDHS
Contact information
Practice address
USCG HQ COMDT (CG-1122), 2100 SECOND ST., SW, WASHINGTON, DC 20593-0001
(202) 475-5181
(202) 475-5909
Mailing address
USCG HQ COMDT (CG-1122), 2100 SECOND ST., SW, WASHINGTON, DC 20593-0001
(202) 475-5181
(202) 475-5909
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
—
—
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
11/16/2007
Last updated
11/29/2010
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