MEDICARE: DANIELLE MARIE SCHWADERER KETTLER N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	AHC-NAT-LIC-2798	MT
2	175F00000X	Naturopath	ND-430	CA

General Provider Information

NPI Number	:	1083914683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MARIE SCHWADERER KETTLER N.D.

Provider Business Mailing Address
First Line	:	651 1ST ST W STE B
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7046
Country	:	US
Telephone Number	:	707-996-4656
Fax Number	:

Provider Business Practice Location Address
First Line	:	651 1ST ST W STE B
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7046
Country	:	US
Telephone Number	:	707-996-4656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	06/19/2023

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