Provider Demographics
NPI:1689012353
Name:ANDERSEN, DANETTE RACHELLE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:RACHELLE
Last Name:ANDERSEN
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 1:3614 COLE MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1120
Mailing Address - Country:US
Mailing Address - Phone:704-608-8915
Mailing Address - Fax:
Practice Address - Street 1:6010 CARNEGIE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-4637
Practice Address - Country:US
Practice Address - Phone:704-384-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10912881174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN