Provider Demographics
NPI:1730648486
Name:MCMILLAN, DANIELLE (IBCLC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MCMILLAN
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 1:210 NORTH ST NE
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-4002
Mailing Address - Country:US
Mailing Address - Phone:276-337-0142
Mailing Address - Fax:
Practice Address - Street 1:210 NORTH ST NE
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-4002
Practice Address - Country:US
Practice Address - Phone:276-337-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA255220174N00000X
VAL-314143174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN