=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316351133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOMINIQUE A UVA FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2014
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 ROE AVE ARNOT OGDEN MEDICAL CENTER
-----------------------------------------------------
City | ELMIRA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-737-4100
-----------------------------------------------------
Fax | 607-271-7080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5941 FARRINGTON ROAD
-----------------------------------------------------
City | CICERO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-935-3882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 338763
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP171181
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 338763
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------