Individual
DEJA HARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 BLESSING CIR, SUFFOLK, VA 23434-7682
(706) 631-2223
Mailing address
111 BLESSING CIR, SUFFOLK, VA 23434-7682
(706) 631-2223
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/30/2025
Last updated
05/30/2025
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