Provider Demographics
NPI:1770017022
Name:HARGROVE, DANELLE
Entity type:Individual
Prefix:
First Name:DANELLE
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 CENTERBROOKE LN
Mailing Address - Street 2:STE F #145
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8291
Mailing Address - Country:US
Mailing Address - Phone:804-590-6394
Mailing Address - Fax:757-809-1543
Practice Address - Street 1:205 OAK MANOR CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4076
Practice Address - Country:US
Practice Address - Phone:804-590-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)