Provider Demographics
NPI:1114539871
Name:BRAMBLE, JARETH JUNIOR
Entity type:Individual
Prefix:
First Name:JARETH
Middle Name:JUNIOR
Last Name:BRAMBLE
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 1:2162 ALICE AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3540
Mailing Address - Country:US
Mailing Address - Phone:240-330-2437
Mailing Address - Fax:
Practice Address - Street 1:3423 5TH ST SE APT 12
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5443
Practice Address - Country:US
Practice Address - Phone:120-255-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker