Provider Demographics
NPI:1063089613
Name:DANIELS, KATHLEEN (IBCLC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DANIELS
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 1:6502 N SHORE SQ
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6443
Mailing Address - Country:US
Mailing Address - Phone:617-259-0282
Mailing Address - Fax:
Practice Address - Street 1:6502 N SHORE SQ
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6443
Practice Address - Country:US
Practice Address - Phone:617-259-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-149678163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant