Individual
DOMINIQUE MICHELLE DEBROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
105 LYON ST FL 2, PATERSON, NJ 07524-1933
(347) 722-4124
Mailing address
105 LYON ST FL 2, PATERSON, NJ 07524-1933
(347) 722-4124
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
315847
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
315847
—
NY
Enumeration date
08/15/2018
Last updated
08/15/2018
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