Provider Demographics
NPI:1831829035
Name:MCCLONE, DANIELLE M (DNP)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:M
Last Name:MCCLONE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:FOTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6800
Mailing Address - Fax:414-337-7068
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6800
Practice Address - Fax:414-337-7068
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13100363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics