Provider Demographics
NPI:1285692830
Name:DOMINICCI, JOHELEN ERIKA (RN)
Entity type:Individual
Prefix:
First Name:JOHELEN
Middle Name:ERIKA
Last Name:DOMINICCI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOHELEN
Other - Middle Name:ERIKA
Other - Last Name:APONTE JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 10820
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-0820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WEED ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:BLD 166
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-0820
Practice Address - Country:US
Practice Address - Phone:760-380-3114
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9226285163W00000X
PR025653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse