Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024178449 | VA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 0024178449 | VA |
NPI | 1003450941 |
---|---|
Provider Name | Mrs. Danielle Susan Cavallo-Fat |
First Address | Chesapeake, VA 23320-3144 |
Second Address | Chesapeake, VA 23320-3144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2019 |
Last Update Date | 04/11/2019 |