Individual
DESTINI DARNE'A MANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4614 EASTLAWN AVE, DALE CITY, VA 22193-2219
(419) 442-9251
Mailing address
4614 EASTLAWN AVE, DALE CITY, VA 22193
(419) 442-9251
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/22/2021
Last updated
04/22/2021
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