Healthcare Provider Details

I. General information

NPI: 1013063957
Provider Name (Legal Business Name): EDMEE MARGUERITE DANAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N DUTTON AVE
SANTA ROSA CA
95401-4606
US

IV. Provider business mailing address

120 PLEASANT HILL AVE N SUITE 370
SEBASTOPOL CA
95472-3164
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-3600
  • Fax:
Mailing address:
  • Phone: 707-823-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberA43309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: