Provider Demographics
NPI:1740726199
Name:BIBEAULT, DANIELLE (NP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BIBEAULT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:FRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3640 HIGH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3213
Mailing Address - Country:US
Mailing Address - Phone:757-215-3565
Mailing Address - Fax:757-397-8026
Practice Address - Street 1:3640 HIGH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707
Practice Address - Country:US
Practice Address - Phone:757-215-3565
Practice Address - Fax:757-397-8026
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10539Medicare PIN