Provider Demographics
NPI:1174118434
Name:JOHNSON, DOMINIQUE (RN)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 OAKWOOD ST SE APT 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1754
Mailing Address - Country:US
Mailing Address - Phone:214-502-2277
Mailing Address - Fax:
Practice Address - Street 1:210 OAKWOOD ST SE APT 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1754
Practice Address - Country:US
Practice Address - Phone:214-502-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse