Provider Demographics
NPI:1992157770
Name:DOKMANOVICH, DAVID RICHARD (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:DOKMANOVICH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3209 W SMITH VALLEY RD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8495
Mailing Address - Country:US
Mailing Address - Phone:317-807-6789
Mailing Address - Fax:317-300-7116
Practice Address - Street 1:3209 W SMITH VALLEY RD
Practice Address - Street 2:SUITE 146
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8495
Practice Address - Country:US
Practice Address - Phone:317-807-6789
Practice Address - Fax:317-300-7116
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171WH0202XOther Service ProvidersContractorHome Modifications