Provider Demographics
NPI:1306127865
Name:ANTOINE, DOMINIQUE (RN)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138-56 233 STREET
Mailing Address - Street 2:
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1903
Mailing Address - Country:US
Mailing Address - Phone:347-235-3365
Mailing Address - Fax:
Practice Address - Street 1:138-56 233 STREET
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11422-1903
Practice Address - Country:US
Practice Address - Phone:347-235-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY642891-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care