Provider Demographics
NPI:1811656374
Name:BRACKETT, DONTE
Entity type:Individual
Prefix:
First Name:DONTE
Middle Name:
Last Name:BRACKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL GUANTANAMO BAY
Mailing Address - Street 2:PSC 1005 BOX 110185
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34009
Mailing Address - Country:US
Mailing Address - Phone:757-650-1140
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GUANTANAMO BAY
Practice Address - Street 2:PSC 1005 BOX NUMBER 110185
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34009
Practice Address - Country:US
Practice Address - Phone:757-650-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86150204133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered