Provider Demographics
NPI:1003842386
Name:NETH, JASON SHANE (CORPSMAN)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:SHANE
Last Name:NETH
Suffix:
Gender:M
Credentials:CORPSMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7307
Mailing Address - Country:US
Mailing Address - Phone:907-966-5477
Mailing Address - Fax:
Practice Address - Street 1:204 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7307
Practice Address - Country:US
Practice Address - Phone:907-966-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other