Most Relevant Information
Provider Data
| NPI Number: | 1003563875 |
| Provider Name: | AARON DEATHERAGE |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/02/2022 |
| Last Updated: | 03/02/2022 |
Provider Practice Location
1909 31ST AVE SW APT 344
MINOT
ND
587017469
Practice Location Phone/Fax
| Phone: | 9092133973 |
| Fax: |
Provider Mailing Location
1909 31ST AVE SW APT 344
MINOT
ND
587017469
Provider Mailing Phone/Fax
| Phone: | 9092133973 |
| Fax: |