Individual
DOMINIQUE MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
502 W 5TH NORTH ST, SUMMERVILLE, SC 29483-6105
(737) 226-6700
Mailing address
3066 TALLGRASS BLF, ROCK HILL, SC 29732-5527
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23773
SC
Other
Enumeration date
04/30/2020
Last updated
12/01/2020
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