Provider Demographics
NPI:1619411691
Name:NAZARENKO, DANIELLE NICHOLE (CNM)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:NICHOLE
Last Name:NAZARENKO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27 SMITH ST # 233
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-4500
Mailing Address - Country:US
Mailing Address - Phone:781-797-0762
Mailing Address - Fax:413-642-2563
Practice Address - Street 1:27 SMITH STREET
Practice Address - Street 2:#233
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-4500
Practice Address - Country:US
Practice Address - Phone:781-797-0762
Practice Address - Fax:413-642-2563
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2281988367A00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374J00000XNursing Service Related ProvidersDoula