Provider Demographics
NPI:1154912137
Name:OLIVER, DOMINIQUE SHONTAE (STNA)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:SHONTAE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4237
Mailing Address - Country:US
Mailing Address - Phone:216-512-3217
Mailing Address - Fax:
Practice Address - Street 1:3361 E 149TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4237
Practice Address - Country:US
Practice Address - Phone:216-512-3217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care