Provider Demographics
NPI:1730876293
Name:BROWN, DOMINIQUE QUANTASIA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:QUANTASIA MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:DOMINIQUE
Other - Middle Name:QUANTASIA MARIE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 ELECTRONICS PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:417 ELECTRONICS PKWY
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6001
Practice Address - Country:US
Practice Address - Phone:315-234-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY840571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse