Healthcare Provider Details

I. General information

NPI: 1124462387
Provider Name (Legal Business Name): DANIELLE KATHRYN IVANOVA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21540 30TH DR SE STE 400
BOTHELL WA
98021-7015
US

IV. Provider business mailing address

1119A YAKIMA AVE S
SEATTLE WA
98144-3147
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-5442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO.OP.60943716
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: