Provider Demographics
NPI:1083806814
Name:TONELLI, DANIELLE G (DO)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:G
Last Name:TONELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3300
Mailing Address - Country:US
Mailing Address - Phone:920-261-8500
Mailing Address - Fax:920-261-8828
Practice Address - Street 1:127 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3300
Practice Address - Country:US
Practice Address - Phone:920-261-8500
Practice Address - Fax:920-261-8828
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49881-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43542600Medicaid
WI49881-21OtherWI LICENSE