Provider Demographics
NPI:1326356403
Name:MCKENNA, DANIELLE ROSE (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:ROSE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:1045 BEECHER XING N
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4573
Mailing Address - Country:US
Mailing Address - Phone:614-304-0019
Mailing Address - Fax:614-304-0023
Practice Address - Street 1:6670 PERIMETER DR
Practice Address - Street 2:SUITE 240
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8056
Practice Address - Country:US
Practice Address - Phone:614-339-2000
Practice Address - Fax:614-339-2003
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2017-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHBG4690395-M91213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074533Medicaid
OHH127982Medicare PIN
OH0074533Medicaid
OHH127980Medicare PIN
OHH127981Medicare PIN