Provider Demographics
NPI:1679729164
Name:MAGNESS-WELLMANN, DANIELLE LIN (DO)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LIN
Last Name:MAGNESS-WELLMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8674 1230 E. MAIN STREET
Mailing Address - Street 2:MANKATO CLINIC, LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1400 MADISON AVE SUITE 352
Practice Address - Street 2:MANKATO CLINIC DEPARTMENT OF PSYCHIATRY AND PSYCHOLOGY
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN551142084P0800X
IL1250546602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry