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General NPI Number Information
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NPI Number | 1225713829
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Entity Type | Individual
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Provider Name | DOMINIQUE EBONIECE MCLAUGHLIN
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Gender | Female
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 6414 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6203
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Country | US
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Telephone | 718-805-0037
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Fax | 866-221-0879
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Provider Business Mailing Address
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Address Line | PO BOX 211226
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City | WOODHAVEN
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State | NY
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Zip | 11421-6226
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Country | US
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Telephone | 917-932-7378
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Fax | 866-221-0879
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 355973
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023006023
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95026260
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License Number State | CA
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