Provider Demographics
NPI:1609646231
Name:LISTHROP, DANIELLE (NP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LISTHROP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MALLORY
Other - Last Name:LISTHROP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:88 ROOSEVELT AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 MAIN ST STE D1
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2136
Practice Address - Country:US
Practice Address - Phone:866-815-6799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01476000363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care