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Individual

DANETTE E NICHOLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGNP

Contact information

Practice address
2700 PROSPERITY AVE STE 270, FAIRFAX, VA 22031-4321
(703) 698-2431
(703) 665-6878
Mailing address
50 IRVING ST NW, WASHINGTON, DC 20422
(202) 745-8000

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024173894
VA
363LA2200X
Adult Health Nurse Practitioner
002417389
VA
363LG0600X
Gerontology Nurse Practitioner
0024173894
VA

Other

Enumeration date
09/07/2016
Last updated
11/27/2023
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