Provider Demographics
NPI:1285197491
Name:FOHL, DANIELLE (FNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:FOHL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6297 US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:47016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7777 YANKEE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-3500
Practice Address - Country:US
Practice Address - Phone:513-803-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHAPRN.CNP.024555363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program