Provider Demographics
NPI:1710387089
Name:WENTWORTH, DANIELLE S (FNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:S
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:S
Other - Last Name:KRUGLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 LEE STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-3363
Practice Address - Country:US
Practice Address - Phone:434-924-5969
Practice Address - Fax:434-982-0522
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00517500363LF0000X
VA0024172606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily