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DOMINIQUE ETIENNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1603 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1019
(215) 242-2439
(215) 242-2596
Mailing address
1603 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1019
(215) 242-2439
(215) 242-2596

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00317800
NJ
363A00000X
Physician Assistant
Primary
MA056503
PA

Other

Enumeration date
11/04/2013
Last updated
06/05/2015
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