Provider Demographics
NPI:1083914683
Name:SCHWADERER KETTLER, DANIELLE MARIE (ND)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:SCHWADERER KETTLER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:SCHWADERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:651 1ST ST W STE B
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-7046
Mailing Address - Country:US
Mailing Address - Phone:707-996-4656
Mailing Address - Fax:
Practice Address - Street 1:651 1ST ST W STE B
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7046
Practice Address - Country:US
Practice Address - Phone:707-996-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-2798175F00000X
CAND-430175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath