MEDICARE: DOMINIQUE BLAGOJEVIC APRN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.0031786	OH

General Provider Information

NPI Number	:	1821725888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE BLAGOJEVIC APRN CNP

Provider Business Mailing Address
First Line	:	5147 MANCHESTER RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319-3911
Country	:	US
Telephone Number	:	330-644-3747
Fax Number	:	330-644-9815

Provider Business Practice Location Address
First Line	:	5147 MANCHESTER RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319-3911
Country	:	US
Telephone Number	:	330-644-3747
Fax Number	:	330-644-9815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	11/07/2025

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