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General NPI Number Information
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NPI Number | 1609646231
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Entity Type | Individual
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Provider Name | DANIELLE LISTHROP NP
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Gender | Female
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 23 MAIN ST STE D1
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City | HOLMDEL
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State | NJ
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Zip | 07733-2136
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Country | US
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Telephone | 866-815-6799
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Fax |
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Provider Business Mailing Address
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Address Line | 88 ROOSEVELT AVE APT 204
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City | CARTERET
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State | NJ
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Zip | 07008-2584
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 26NJ01476000
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License Number State | NJ
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