Provider Demographics
NPI:1144181363
Name:DODGE, MONIQUE RENAE
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:RENAE
Last Name:DODGE
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 1:611 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4274
Mailing Address - Country:US
Mailing Address - Phone:360-773-9378
Mailing Address - Fax:
Practice Address - Street 1:611 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4274
Practice Address - Country:US
Practice Address - Phone:360-773-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABDC.BD.70053848374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula