Provider Demographics
NPI:1699579581
Name:DOMINION HEALTHCARE CLINIC
Entity type:Organization
Organization Name:DOMINION HEALTHCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFRED
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:484-402-0166
Mailing Address - Street 1:208 BANTRY ST
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-3190
Mailing Address - Country:US
Mailing Address - Phone:484-402-0166
Mailing Address - Fax:
Practice Address - Street 1:6536 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2215
Practice Address - Country:US
Practice Address - Phone:484-402-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center