Provider Demographics
NPI:1396271565
Name:BRITTON-DOMINIQUE, KARLISHA (CLT, RN)
Entity type:Individual
Prefix:MRS
First Name:KARLISHA
Middle Name:
Last Name:BRITTON-DOMINIQUE
Suffix:
Gender:F
Credentials:CLT, RN
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:DOMINIQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLT, RN
Mailing Address - Street 1:1760 E PECOS RD STE 431
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3209
Mailing Address - Country:US
Mailing Address - Phone:480-780-4330
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD STE 431
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3209
Practice Address - Country:US
Practice Address - Phone:480-780-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95370898163W00000X
AZ280846163WG0000X, 163WI0500X, 163WX0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WX0200XNursing Service ProvidersRegistered NurseOncology