Individual
MRS. DOMINIQUE CERISE ERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3276 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4005
(479) 404-2110
(479) 404-2111
Mailing address
3276 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4005
(479) 404-2110
(479) 404-2111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4835-23
WI
Other
Enumeration date
10/16/2019
Last updated
12/28/2021
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