Individual
DOMONIQUE NATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MS
Contact information
Practice address
10800 KNIGHTS RD, PHILADELPHIA, PA 19114-4200
(215) 612-5161
Mailing address
10800 KNIGHTS RD, PHILADELPHIA, PA 19114-4200
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
MT235348
PA
Other
Enumeration date
06/11/2025
Last updated
06/11/2025
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