Provider Demographics
NPI:1033666003
Name:NICHOLES, DANETTE E (AGNP)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:E
Last Name:NICHOLES
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:E
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:50 IRVING ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20422
Mailing Address - Country:US
Mailing Address - Phone:202-745-8000
Mailing Address - Fax:
Practice Address - Street 1:2700 PROSPERITY AVE STE 270
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4321
Practice Address - Country:US
Practice Address - Phone:703-698-2431
Practice Address - Fax:703-665-6878
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173894363LG0600X, 363L00000X
VA002417389363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health