Individual
DANIELLE NICOLE BLACKMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 444-2000
Mailing address
64 PENNY DR, CALVERTON, NY 11933-1130
(516) 768-5174
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
634244
NY
363LN0000X
Neonatal Nurse Practitioner
Primary
350560
NY
Other
Enumeration date
06/03/2022
Last updated
11/29/2022
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