Healthcare Provider Details

I. General information

NPI: 1285692830
Provider Name (Legal Business Name): JOHELEN ERIKA DOMINICCI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JOHELEN ERIKA APONTE JORDAN RN

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEED ARMY COMMUNITY HOSPITAL BLD 166
FORT IRWIN CA
92310-0820
US

IV. Provider business mailing address

PO BOX 10820
FORT IRWIN CA
92310-0820
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9226285
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number025653
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: