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General NPI Number Information
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NPI Number | 1013891043
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Entity Type | Individual
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Provider Name | DOMINIQUE NICOLE HORAH-NANEZ
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 240 INDIAN RIVER RD STE C7
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City | ORANGE
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State | CT
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Zip | 06477-3691
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Country | US
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Telephone | 203-383-9846
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Fax |
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Provider Business Mailing Address
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Address Line | 21 BHASKING RIDGE RD
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City | WILTON
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State | CT
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Zip | 06897-3204
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Country | US
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Telephone | 203-820-0751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 14719
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License Number State | CT
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