Healthcare Provider Details

I. General information

NPI: 1174706956
Provider Name (Legal Business Name): DANIT WEHLE RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HAWTHORNE PL APT F4
MONTCLAIR NJ
07042-2621
US

IV. Provider business mailing address

65 HAWTHORNE PL APT F4
MONTCLAIR NJ
07042-2621
US

V. Phone/Fax

Practice location:
  • Phone: 973-866-0039
  • Fax: 973-866-0039
Mailing address:
  • Phone: 973-866-0039
  • Fax: 973-866-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number26NR13512400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: