Provider Demographics
NPI:1225713829
Name:MCLAUGHLIN, DOMINIQUE EBONIECE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:EBONIECE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:E
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 211226
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-6226
Mailing Address - Country:US
Mailing Address - Phone:917-932-7378
Mailing Address - Fax:866-221-0879
Practice Address - Street 1:6414 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6203
Practice Address - Country:US
Practice Address - Phone:718-805-0037
Practice Address - Fax:866-221-0879
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355973363LF0000X
CA2023006023363LF0000X
CANP95026260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily