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General NPI Number Information
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NPI Number | 1336675529
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Entity Type | Individual
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Provider Name | DOMENIQUE EDWARDS ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/07/2017
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 5602 CALIFORNIA AVE SW
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City | SEATTLE
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State | WA
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Zip | 98136-1515
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Country | US
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Telephone | 206-538-2255
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Fax | 206-538-2266
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Provider Business Mailing Address
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Address Line | 2611 SW NEVADA ST UNIT B
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City | SEATTLE
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State | WA
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Zip | 98126-2535
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Country | US
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Telephone | 206-920-5949
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60786069
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60793275
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License Number State | WA
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