Provider Demographics
NPI:1356418339
Name:HARTGERINK, BRADLEY JAY (CRNA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAY
Last Name:HARTGERINK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3605 HUSTED DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-915-0380
Mailing Address - Fax:301-295-5063
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CTR
Practice Address - Street 2:8901 WISCONSIN AVE.
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4455
Practice Address - Fax:301-295-5063
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704161718163W00000X
VA0024164647367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse