Active NPI
Dana Shay Therkildsen, IDC
- Independent Duty Corpsman
- Bremerton, WA
National Provider Identifier
1003944836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 1 Boone Rd
Bremerton, WA 98312-1894 - Phone
- (360) 475-4887
- Fax
- (360) 475-4522
- NPI assigned
- Mar 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
1 Boone Rd
Bremerton, WA 98312-1894
Mailing address
Uss John C Stennis Cvn74
PO Box 67
Fpo, AP 96615
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710I1002X | Other | INDEPENDENT DUTY CORPSMAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384387200000",
"number": "1003944836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "USS JOHN C STENNIS CVN74",
"address_2": "PO BOX 67",
"city": "FPO",
"state": "AP",
"postal_code": "96615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOONE RD",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983121894",
"telephone_number": "360-475-4887",
"fax_number": "360-475-4522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THERKILDSEN",
"first_name": "DANA",
"middle_name": "SHAY",
"credential": "IDC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2013-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT DUTY CORPSMAN",
"identifier": "1710I1002X",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.