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General NPI Number Information
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NPI Number | 1699579581
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Entity Type | Organization
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Legal Business Name | DOMINION HEALTHCARE CLINIC LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 6536 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2215
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Country | US
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Telephone | 484-402-1660
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Fax | 856-935-9123
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Provider Business Mailing Address
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Address Line | 208 BANTRY ST
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City | SWEDESBORO
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State | NJ
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Zip | 08085-3190
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Country | US
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Telephone | 484-402-0166
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Fax | 856-935-9123
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | BERNADETT ALFRED
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Credential | APN
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Telephone | 484-402-0166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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