Individual
DOMINIQUE ANN ERTOLACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
609 W MAPLE AVE, SPRINGDALE, AR 72764-5335
(479) 553-1000
Mailing address
609 W MAPLE AVE, SPRINGDALE, AR 72764-5335
(360) 560-8999
(479) 553-1000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
121999
AR
Other
Enumeration date
08/21/2019
Last updated
09/17/2019
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