Provider Demographics
NPI:1700233855
Name:HAFER, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HAFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33290 CHINCOTEAGUE RD
Mailing Address - Street 2:
Mailing Address - City:WALLOPS ISLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23337-2204
Mailing Address - Country:US
Mailing Address - Phone:703-463-6190
Mailing Address - Fax:
Practice Address - Street 1:33290 CHINCOTEAGUE RD
Practice Address - Street 2:
Practice Address - City:WALLOPS ISLAND
Practice Address - State:VA
Practice Address - Zip Code:23337-2204
Practice Address - Country:US
Practice Address - Phone:703-463-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001145188282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital