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General NPI Number Information
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NPI Number | 1831554682
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Entity Type | Individual
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Provider Name | BRETTNEY DAUGHERTY N.P., D.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 1711 OCEAN PARK BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90405-4901
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Country | US
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Telephone | 310-450-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 648 SUNFISH WAY
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City | PORT HUENEME
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State | CA
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Zip | 93041-3504
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Country | US
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Telephone | 661-747-3788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95003505
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License Number State | CA
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