Provider Demographics
NPI:1538884440
Name:WASHINGTON, DOMINIQUE KHIREE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:KHIREE
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 ARLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCIAL POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43116-6523
Mailing Address - Country:US
Mailing Address - Phone:614-657-7615
Mailing Address - Fax:
Practice Address - Street 1:290 ARLEDGE DR
Practice Address - Street 2:
Practice Address - City:COMMERCIAL POINT
Practice Address - State:OH
Practice Address - Zip Code:43116-6523
Practice Address - Country:US
Practice Address - Phone:614-657-7615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker