Provider Demographics
NPI:1861864159
Name:MELICAN, DANIELLE ANN (CNM)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANN
Last Name:MELICAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MARY ST
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1812
Mailing Address - Country:US
Mailing Address - Phone:609-440-8859
Mailing Address - Fax:
Practice Address - Street 1:2490 PENNINGTON RD
Practice Address - Street 2:#204
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5225
Practice Address - Country:US
Practice Address - Phone:609-737-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00058600176B00000X
PAMW010384176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife