Healthcare Provider Details

I. General information

NPI: 1669027280
Provider Name (Legal Business Name): DANIELLE KRISTINE BRAITHWAITE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SANTA ROSA RD RM 114
HENRICO VA
23229-5109
US

IV. Provider business mailing address

1504 SANTA ROSA RD RM 114
HENRICO VA
23229-5109
US

V. Phone/Fax

Practice location:
  • Phone: 804-210-3103
  • Fax:
Mailing address:
  • Phone: 804-210-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024195991
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: