Provider Demographics
NPI:1275020158
Name:BOONE, DANELLE JEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANELLE
Middle Name:JEAN
Last Name:BOONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:DANELLE
Other - Middle Name:JEAN
Other - Last Name:MIEDEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3051 STONEBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5308
Mailing Address - Country:US
Mailing Address - Phone:712-363-4362
Mailing Address - Fax:
Practice Address - Street 1:396 PORTLAND WAY NORTH
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1115
Practice Address - Country:US
Practice Address - Phone:419-468-3668
Practice Address - Fax:419-462-5037
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH36.004011213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program