Provider Demographics
NPI:1215286976
Name:BROCK, DANNA MARIA (CNP)
Entity type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:MARIA
Last Name:BROCK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:DANNA
Other - Middle Name:MARIA
Other - Last Name:LORENZETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:439 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5119
Mailing Address - Country:US
Mailing Address - Phone:707-889-2709
Mailing Address - Fax:
Practice Address - Street 1:439 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5119
Practice Address - Country:US
Practice Address - Phone:707-206-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-09
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253912363LA2200X, 363L00000X
CAA0912016363LA2200X
CA95003529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95003529OtherMEDICAL LIC