Provider Demographics
NPI:1104948389
Name:DOMINGUEZ, BARBARA (APRN, BC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 KENLIWORTH TERRACE NE
Mailing Address - Street 2:PARKSIDE HEALTH CENTER,
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-388-8160
Mailing Address - Fax:202-548-8685
Practice Address - Street 1:765 KENILWORTH TER NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1898
Practice Address - Country:US
Practice Address - Phone:202-388-8160
Practice Address - Fax:202-548-8586
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN966578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily