Healthcare Provider Details

I. General information

NPI: 1326356403
Provider Name (Legal Business Name): DANIELLE ROSE MCKENNA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6670 PERIMETER DR SUITE 240
DUBLIN OH
43016-8056
US

IV. Provider business mailing address

1045 BEECHER XING N SUITE A
GAHANNA OH
43230-4573
US

V. Phone/Fax

Practice location:
  • Phone: 614-339-2000
  • Fax: 614-339-2003
Mailing address:
  • Phone: 614-304-0019
  • Fax: 614-304-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberBG4690395-M91
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: