Healthcare Provider Details

I. General information

NPI: 1740726199
Provider Name (Legal Business Name): DANIELLE BIBEAULT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE FRANO NP

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 HIGH ST SUITE 1A
PORTSMOUTH VA
23707
US

IV. Provider business mailing address

3640 HIGH ST SUITE 1A
PORTSMOUTH VA
23707-3213
US

V. Phone/Fax

Practice location:
  • Phone: 757-215-3565
  • Fax: 757-397-8026
Mailing address:
  • Phone: 757-215-3565
  • Fax: 757-397-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024174076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: