Healthcare Provider Details

I. General information

NPI: 1063089613
Provider Name (Legal Business Name): KATHLEEN DANIELS PMHNP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

IV. Provider business mailing address

6502 N SHORE SQ
NEW MARKET MD
21774-6443
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-9688
  • Fax:
Mailing address:
  • Phone: 617-259-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR219138
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-149678
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: