Provider Demographics
NPI:1548745078
Name:O'REGGIO-BRADSHAW, DANIELLE RENEE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:O'REGGIO-BRADSHAW
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:O'REGGIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1305 KILDARE CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5652
Mailing Address - Country:US
Mailing Address - Phone:347-586-2734
Mailing Address - Fax:
Practice Address - Street 1:423 FORTRESS BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1351
Practice Address - Country:US
Practice Address - Phone:304-225-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00854400363LF0000X
NY343652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily