Individual
DOMINIQUE CAPORUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
650 SPRUCEWOOD LN, ERLANGER, KY 41018-1062
(859) 282-6600
Mailing address
22 CASAGRANDE ST, FORT THOMAS, KY 41075-4023
(859) 512-7050
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TC835
KY
Other
Enumeration date
06/12/2019
Last updated
01/17/2022
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