Healthcare Provider Details

I. General information

NPI: 1205232097
Provider Name (Legal Business Name): DANIELLE MAREENE LAFOLLETTE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 N MAIN ST STE 300
WOODSTOCK VA
22664-1703
US

IV. Provider business mailing address

PO BOX 25
WARDENSVILLE WV
26851-0025
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-5180
  • Fax: 540-459-4067
Mailing address:
  • Phone: 540-335-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001242405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: