Provider Demographics
NPI:1316351133
Name:UVA, DOMINIQUE A (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:A
Last Name:UVA
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:A
Other - Last Name:GUADALUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5941 FARRINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039
Mailing Address - Country:US
Mailing Address - Phone:315-935-3882
Mailing Address - Fax:
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:ARNOT OGDEN MEDICAL CENTER
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-737-4100
Practice Address - Fax:607-271-7080
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338763363LF0000X, 363L00000X
MECNP171181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0399067Medicaid
NY03990672Medicaid
NYJ400162857Medicare PIN