Provider Demographics
NPI:1326462714
Name:RONCO, DANIELLE M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:RONCO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 LOCUST ST APT 303
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1537
Mailing Address - Country:US
Mailing Address - Phone:314-281-1760
Mailing Address - Fax:
Practice Address - Street 1:5000 CEDAR PLAZA PKWY STE 350
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-843-4333
Practice Address - Fax:314-569-0441
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019973163W00000X
MO2019007536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse