Provider Demographics
NPI:1245652734
Name:ALLEN, DANIELLE M (CRNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:DUBOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-840-4534
Mailing Address - Fax:856-762-2853
Practice Address - Street 1:200 BOWMAN DRIVE
Practice Address - Street 2:SUITE E385 BACK
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-840-4534
Practice Address - Fax:856-762-2853
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013633363LG0600X
NJ26NJ00604200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0524719Medicaid