Provider Demographics
NPI:1326726456
Name:BLUMER, DANIELLE SUSANNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SUSANNE
Last Name:BLUMER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 PARK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1901
Mailing Address - Country:US
Mailing Address - Phone:864-918-5780
Mailing Address - Fax:
Practice Address - Street 1:1416 PARK AVE STE 201
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1901
Practice Address - Country:US
Practice Address - Phone:864-918-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3055881163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant