Individual
JACQUELINE D DOMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
301 HOSPITAL DR, GLEN BURNIE, MD 21061-5803
(410) 787-4000
Mailing address
300 HOSPITAL DR, SUITE 215, GLEN BURNIE, MD 21061-6902
(410) 787-4000
(410) 787-4846
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R097460
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127573
JOHNS HOPKINS HEALTH CARE
MD
05
—
408588400
—
MD
01
—
4457
BRAVO/ELDER HEALTH
MD
01
—
64696401
CARE FIRST BLUE CROSS
MD
01
—
F591-0020
CARE FIRST BLUE CROSS
DC
Enumeration date
11/18/2005
Last updated
12/03/2007
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