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Individual
SARA DEATHERAGE
Active
Individual
SARA DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
819106
CA
363LF0000X
Family Nurse Practitioner
Primary
0024177684
VA
Other
Enumeration date
09/14/2016
Last updated
02/21/2024
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