Provider Demographics
NPI:1073994018
Name:COVACH, DANIELLE M (DO)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:COVACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:FENSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:835 PARKSIDE ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-8335
Mailing Address - Country:US
Mailing Address - Phone:920-745-3520
Mailing Address - Fax:920-926-7932
Practice Address - Street 1:835 PARKSIDE ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-8505
Practice Address - Country:US
Practice Address - Phone:920-745-3520
Practice Address - Fax:920-745-3520
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine