Provider Demographics
NPI:1497112494
Name:KELLY, DANIELLE RENEE (RNC, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:RENEE
Last Name:KELLY
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BERGEN TPKE
Mailing Address - Street 2:1-K
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2336
Mailing Address - Country:US
Mailing Address - Phone:201-658-0711
Mailing Address - Fax:
Practice Address - Street 1:205 BERGEN TPKE
Practice Address - Street 2:1-K
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-2336
Practice Address - Country:US
Practice Address - Phone:201-658-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12428200163W00000X
NJL-68064163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse