=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174787725
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE M MANN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2008
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1023 NEW MOODY LANE SUITE 103
-----------------------------------------------------
City | LAGRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-222-5558
-----------------------------------------------------
Fax | 502-222-3040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 STANLEY GAULT PKWY STE 129
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40223-5176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-253-4917
-----------------------------------------------------
Fax | 502-489-5751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 036121101
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 03261
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------