Healthcare Provider Details

I. General information

NPI: 1871965277
Provider Name (Legal Business Name): DANIELLE GANGE, NP-C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2015
Last Update Date: 02/05/2021
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax: 757-460-4655
Mailing address:
  • Phone: 757-460-4655
  • Fax: 757-460-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024170939
License Number StateVA

VIII. Authorized Official

Name: DANIELLE GANGE
Title or Position: OWNER
Credential: NP-C
Phone: 757-460-4655