Provider Demographics
NPI:1992114078
Name:HALLANY, DOMINIQUE CRYSTAL (HHA)
Entity type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:CRYSTAL
Last Name:HALLANY
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 TOLEDO TER
Mailing Address - Street 2:APT. H3
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1961
Mailing Address - Country:US
Mailing Address - Phone:240-855-3750
Mailing Address - Fax:
Practice Address - Street 1:3425 TOLEDO TER
Practice Address - Street 2:APT. H3
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1961
Practice Address - Country:US
Practice Address - Phone:240-855-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10575251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health