Healthcare Provider Details

I. General information

NPI: 1720595200
Provider Name (Legal Business Name): DANIELLE MARIE HOWERTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE MARIE COOPER

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 383C
SAINT LOUIS MO
63131-2324
US

IV. Provider business mailing address

3009 N BALLAS RD STE 383C
SAINT LOUIS MO
63131-2324
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-4545
  • Fax:
Mailing address:
  • Phone: 314-996-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017469
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017037319
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: