Provider Demographics
NPI:1376633693
Name:USAMEDDAC BAVARIA
Entity Type:Organization
Organization Name:USAMEDDAC BAVARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMMUNIZATION NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:01149972-196-6378
Mailing Address - Street 1:CMR 464 BOX 638
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09226
Mailing Address - Country:DE
Mailing Address - Phone:01149972-196-6378
Mailing Address - Fax:
Practice Address - Street 1:CMR 464 BOX 638
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09226
Practice Address - Country:DE
Practice Address - Phone:01149972-196-6378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2037311261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service