Provider Demographics
NPI:1285030205
Name:MULLEN, DANIELLE (IBCLC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 CURTIS CT N
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1154
Mailing Address - Country:US
Mailing Address - Phone:716-523-9507
Mailing Address - Fax:
Practice Address - Street 1:4715 CURTIS CT N
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1154
Practice Address - Country:US
Practice Address - Phone:716-523-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-64869174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN