Healthcare Provider Details

I. General information

NPI: 1356199939
Provider Name (Legal Business Name): DANIELLE HAZEL KELLNER MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CORLIES AVE
NEPTUNE NJ
07753-5197
US

IV. Provider business mailing address

1945 CORLIES AVE
NEPTUNE NJ
07753-5197
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4196
  • Fax:
Mailing address:
  • Phone: 732-776-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0036040
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15293500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: