Provider Demographics
NPI:1265096762
Name:DEGEARE, ASHLEY HANNAH (NDTR)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:HANNAH
Last Name:DEGEARE
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42918 REDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3639
Mailing Address - Country:US
Mailing Address - Phone:703-304-8466
Mailing Address - Fax:
Practice Address - Street 1:3903 FAIR RIDGE DR STE 209
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2944
Practice Address - Country:US
Practice Address - Phone:703-865-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86131075136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered