Provider Demographics
NPI:1710616966
Name:ASHENBRENER, DANIELLE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:ASHENBRENER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:ASHENBRENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5604
Mailing Address - Country:US
Mailing Address - Phone:573-270-8108
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 3019B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8267
Practice Address - Country:US
Practice Address - Phone:314-509-5305
Practice Address - Fax:314-251-4454
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2022025219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program