Healthcare Provider Details

I. General information

NPI: 1164233102
Provider Name (Legal Business Name): ANGELINA VIVIAN LEIGH DANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA DANNA

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 COVE RD
BROOKINGS OR
97415-2520
US

IV. Provider business mailing address

3587 HEATHROW WAY
MEDFORD OR
97504-4004
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-0222
  • Fax: 541-469-0228
Mailing address:
  • Phone: 541-858-8817
  • Fax: 541-858-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: