Individual
PATRICIA DOMINIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
801 MASSACHUSETTS AVE, CROSSTOWN 2ND FLOOR, BOSTON, MA 02118-2605
(617) 414-4376
(617) 414-4676
Mailing address
720 HARRISON AVE.,, DOB 503, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN268854
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110122168A
—
MA
Enumeration date
04/02/2017
Last updated
09/28/2017
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