Healthcare Provider Details

I. General information

NPI: 1780213892
Provider Name (Legal Business Name): DANIELLE ANISE LARSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE BRANESKY

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E MEMORIAL RD
OKLAHOMA CITY OK
73131-1253
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-7009
  • Fax: 405-330-1811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41164
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: