Provider Demographics
NPI:1912405622
Name:KELLER, NIKOLE (IBCLC, CLC, CD,CIPSP)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:IBCLC, CLC, CD,CIPSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 COLONIAL TER
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1920
Mailing Address - Country:US
Mailing Address - Phone:908-875-8076
Mailing Address - Fax:
Practice Address - Street 1:38 COLONIAL TER
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1920
Practice Address - Country:US
Practice Address - Phone:908-875-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
NJL-307668174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula