Provider Demographics
NPI:1487276192
Name:BRADSHAW, DONNA MARIE (AGNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2251
Mailing Address - Country:US
Mailing Address - Phone:757-424-5778
Mailing Address - Fax:
Practice Address - Street 1:1200 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2251
Practice Address - Country:US
Practice Address - Phone:757-424-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1786365363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty