Brent Thomas Graceffa, IDC
Individual provider Active NPI Independent Duty Corpsman · Rockton, IL
NPI 1306255641 · NPPES record last updated Aug 12, 2014
Key facts
- NPI
- 1306255641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Corpsman 1710I1002X
- Practice address
- 107 Strawbridge Dr
Rockton, IL 61072-2957 - Phone
- (760) 212-1995
- NPI assigned
- Aug 12, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Yes |
Addresses
Primary practice location
107 Strawbridge Dr
Rockton, IL 61072-2957
Mailing address
107 Strawbridge Dr
Rockton, IL 61072-2957
Phone (760) 212-1995
Other providers in Rockton, IL
- Goldie B. Floberg Center
- Goldie B. Floberg Center for Children
- Goldie Floberg Center
- Melissa Marie Gomez
- Jarrett Gordon
- Gunderson Clinic of Chiropractic Inc.
- Dwight Charles Gunderson
- Jeremy A. Gunderson
- Rhett Charles Gunderson
- David D. Hamilton
All providers in Rockton, IL · Independent Duty Corpsman in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.