Healthcare Provider Details

I. General information

NPI: 1558292524
Provider Name (Legal Business Name): DANIELLE BORK CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 25TH ST
TRENTON MO
64683-1078
US

IV. Provider business mailing address

201 E 25TH ST
TRENTON MO
64683-1078
US

V. Phone/Fax

Practice location:
  • Phone: 307-677-5419
  • Fax: 660-650-0020
Mailing address:
  • Phone: 307-677-5419
  • Fax: 660-650-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: