Healthcare Provider Details

I. General information

NPI: 1619435096
Provider Name (Legal Business Name): DANIELLE NICOLE GARCIA WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

IV. Provider business mailing address

5363 MONDAVI DR
SAINT LOUIS MO
63129-3352
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-5190
  • Fax: 314-353-7631
Mailing address:
  • Phone: 314-852-5249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2016038304
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: