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General NPI Number Information
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NPI Number | 1649743972
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Entity Type | Individual
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Provider Name | DOMINIQUE OLIVIER CRNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | BON SECOURS HOSPITAL 2000 WEST BALTIMORE STREET
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City | BALTIMORE
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State | MD
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Zip | 21223
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Country | US
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Telephone | 410-362-3627
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Fax | 410-362-3259
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Provider Business Mailing Address
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Address Line | BON SECOURS MERCY HEALTH 2000 WEST BALTIMORE STREET
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City | BALTIMORE
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State | MD
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Zip | 21223
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Country | US
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Telephone | 410-632-3627
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Fax | 140-632-3259
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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 | R149406
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License Number State | MD
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