Provider Demographics
NPI:1023837465
Name:THOMPSON, DOMINIQUE DUPREE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:DUPREE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CURLEY CT SE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8084
Mailing Address - Country:US
Mailing Address - Phone:330-546-4577
Mailing Address - Fax:
Practice Address - Street 1:38 CURLEY CT SE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8084
Practice Address - Country:US
Practice Address - Phone:330-546-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty