1326356403 NPI number — DR. DANIELLE ROSE MCKENNA DPM

Table of content: DR. DANIELLE ROSE MCKENNA DPM (NPI 1326356403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326356403 NPI number — DR. DANIELLE ROSE MCKENNA DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENNA
Provider First Name:
DANIELLE
Provider Middle Name:
ROSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326356403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1045 BEECHER XING N
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-4573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-304-0019
Provider Business Mailing Address Fax Number:
614-304-0023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6670 PERIMETER DR
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43016-8056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-339-2000
Provider Business Practice Location Address Fax Number:
614-339-2003
Provider Enumeration Date:
09/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  BG4690395-M91 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0074533 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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