Provider Demographics
NPI:1124462387
Name:IVANOVA, DANIELLE KATHRYN (DO)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:KATHRYN
Last Name:IVANOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MS 315010
Mailing Address - Street 2:PO BOX 3547
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124
Mailing Address - Country:US
Mailing Address - Phone:425-467-3655
Mailing Address - Fax:248-849-5378
Practice Address - Street 1:1229 MADISON ST STE 500
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1305
Practice Address - Country:US
Practice Address - Phone:425-326-5338
Practice Address - Fax:425-326-5338
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP609437162084P0800X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1557829Medicaid